Spondyloarthropathies differential diagnosis
Spondyloarthropathies differential diagnosis
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The diagnosis of spondyloarthropathies are generally based on the various clinical criteria and some symptoms and signs such as Inflammatory back pain enthesitis or arthritis with radiographic findings.
Spectrum of Spondyloarthropathies are included:
- Ankylosing spondylitis
- Axial spondylitis
- Peripheral spondylitis
- spondylitis in general
- Psoriatic arthritis
Here are some clinical criteria which have been made throughout different studies to make the diagnosis even more specific and sensitive. These criteria are: 1-ESSG ( The European spondyloarthropathy study group) 2- Amor criteria 3- New York criteria 4- Rome criteria
| ESSG, Amor, New York, and Rome criteria for diagnosis of Spondyloarthropathies | ||||
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| Amor Criteria | ESSG Criteria | Points | New York Criteria | Rome Criteria |
| Inflammatory back pain | Inflammatory spinal pain or synovitis and one of the following: | 1 point | Low back pain with inflammatory characteristics | Low back pain and stiffness for >3 mo that is not relieved by rest |
| Unilateral buttock pain | Alternating buttock pain | 1 point | Limitation of lumbar spine motion in sagittal and frontal planes | Pain and stiffness in the thoracic region |
| Alternating buttock pain | Enthesitis | 2 point | Decreased chest expansion | Limited motion in the lumbar spine |
| Enthesitis | Sacroiliitis | 2 point | Bilateral sacroiliitis grade 2 or higher | Limited chest expansion |
| Peripheral arthritis | IBD | 2 point | Unilateral sacroiliitis grade 3 or higher | History of uveitis |
| Dactylitis (sausage digit) | Positive family history of spondyloarthropathy | 2 point | Definite ankylosing spondylitis when the fourth or fifth criterion mentioned above presents with any clinical criteria | Diagnosis of ankylosing spondylitis when any clinical criteria present with bilateral sacroiliitis grade 2 or higher |
| Acute anterior uveitis | 2 point | |||
| HLA-B27 positive or family history of spondyloarthropathy | 2 point | |||
| Good response to NSAID | 2 point | |||
| Diagnosis of Spondyloarthropathy with 6 or more points | ||||
The New York criteria For diagnosis AS (Clinical and radiographic)
- Chest expansion limitation to 1 inch or less ( measured in 4th intercostal space)
- History or presence of pain in thoracolumbar junction or lumbar spine
- Limitation of the lumbar spine rotation in all directions
Grading of radiographic sacroiliac changes :
- Grade 0 → Normal
- Grade 1 → Suspicious
- Grade 2 → Minimal sacroiliitis
- Grade 3 → Moderate sacroiliitis
- Grade 4 → Ankylosis