Spondyloarthropathy diagnostic study of choice

Diagnostic study of choice

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
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