Friday, June 19, 2009

Criteria for Classification Of AS

I. Calin Criteria (inflammatory back pain)
Four out of 5 must be present:
  1. Age <40
  2. Back pain >3 months
  3. Insidious onset
  4. Improvement with exercise
  5. Early morning stiffness.

II. Rudwaleit criteria (axial spondyloarthropathy)
A positive likelihood ratio of 3.7 is achieved if 2 of 4 criteria are present and increases to 12.4 if 3 of 4 criteria are present:

  1. Morning stiffness >30 minutes
  2. Improvement in back pain with exercise but not with rest
  3. Awakening in the second half of the night because of back pain
  4. Alternating buttock pain.

III. Modified New York criteria for classification
Definite AS if criterion 4 and any one of the other criteria are fulfilled.

  1. Low back pain of at least 3 months' duration that is improved by exercise and not relieved by rest.
  2. Limited lumbar spinal motion in sagittal and frontal planes.
  3. Chest expansion decreased relative to normal values for sex and age.
  4. Bilateral sacroiliitis grade 2 to 4, or unilateral sacroiliitis grade 3 or 4.

IV. European Spondyloarthropathy Study Group (ESSG) criteria
Inflammatory spinal pain or synovitis is:
• Asymmetrical or
• Predominantly in the lower limbs
and 1 or more of the following:
  1. Alternate buttock pain
  2. Sacroiliitis
  3. Enthesitis (inflammation of the tendon or ligament attachments to bone)
  4. Positive FHx spondyloarthropathy
  5. Psoriasis
  6. Inflammatory bowel disease
  7. Urethritis or cervicitis or acute diarrhoea occurring within 1 month before arthritis.
V. Amor criteria
Diagnosis of spondyloarthropathy with 6 or more points:

  1. Inflammatory back pain (1 point)
  2. Unilateral buttock pain (1 point)
  3. Alternating buttock pain (2 points)
  4. Enthesitis (inflammation of the tendon or ligament attachments to bone) (2 points)
  5. Peripheral arthritis (2 points)
  6. Dactylitis (2 points)
  7. Acute anterior uveitis (2 points)
  8. HLA-B27 positive or FHx of spondyloarthropathy (2 points)
  9. Good response to NSAIDs (2 points).

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