Spondyloarthropathy diagnostic study of choice
Diagnostic study of choice
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European League Against Rheumatism reported that the first line of study in in patient with whom suspicious for Spondyloarthropathy is conventional radiography of sacroiliac joints. It has also recommended Magnetic Resonance Imaging (MRI) in the following situations:
- Young patient with new onset of symptoms.
- If the conventional radiography is not diagnostic, but there is strong clinical suspicious.
- To see acute or chronic features of disease ( bone marrow edema, bone erosion or new bone formation )
The basis of the diagnosis of spondyloarthropathy is clinical. Clinical criteria have been made to increase the specificity and sensitivity of the evaluation of clinical symptoms and signs. These criteria are included:
| 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 | ||||