New classification criteria for axial spondylitis by the International Working Group on Spondylitis (ASAS) (2009)
Axial spondylolisthesis (axial spondyloarthritis) is considered in patients under 45 years of age with unexplained low back pain of more than 3 months’ duration who meet the following criteria
Sacroiliac arthritic changes on imaging, plus at least one characteristic manifestation of spondylitis; Jin Di’er, Department of Traditional Chinese Medicine and Rheumatology, China-Japan Friendship Hospital
OR: HLA-B27 positive, plus at least two characteristic manifestations of spondyloarthritis.
Note: Imaging manifestations of sacroiliitis are defined as: active (acute) manifestations of sacroiliac joint inflammation that are highly suggestive of spondylitis on magnetic resonance imaging (MRI), or, radiological manifestations of sacroiliac joint inflammation as determined by the revised New York criteria.
Characteristic manifestations of spondylitis include: inflammatory back pain, arthritis, enthesitis (Achilles tendon), uveitis, dactylitis/toe inflammation, psoriasis, Crohn’s disease/ulcerative colitis, good response to NSAIDs, family history of spondylitis, HLA-B27(+), elevated CRP (only when inflammatory back pain is present as one of the characteristics ).
Inflammatory back pain is defined as: at least 4 of the following 5: first, onset before age 40, second, insidious onset, third, relief with activity, fourth, no relief with rest, and fifth, pain at night that improves upon waking.
Peripheral spondyloarthritis classification criteria
Original source: Ann Rheum Dis 2011;70:25C31
Arthritis, or adhesionitis, or finger (toe) inflammation, plus at least one of the following.
* uveitis
* psoriasis
* inflammatory bowel disease
* Pre-existing infection
* HLA-B27(+)
* Sacroiliac joint imaging changes
Or add at least two of the following (remaining)
* Arthritis
* Adnexitis
* Finger (toe) inflammation
* Prior history of inflammatory back pain
* Family history of spondyloarthritis
Notes.
Arthritis is usually asymmetric oligoarthritis of the lower extremities; arthritis and other inflammatory conditions should be confirmed by a physician; attachment point inflammation is not limited to the Achilles tendon, but can be in other areas as well (limited to Achilles tendon inflammation in the mid-axis SpA classification criteria); attachment point inflammation can occur in the past or present and refers to spontaneous pain or pressure at the attachment point; inflammatory back pain is limited to having been present in the past; if inflammatory back pain is present then the mid-axis SpA Classification criteria; pre-infection means, in arthritis/attachment point infection/finger (toe) infection, present within 1 month prior to onset, UTI/cervicitis/diarrhea;
Family history of spondyloarthritis means: first- or second-degree relative with ① ankylosing spondylitis ② psoriasis ③ acute uveitis ④ reactive arthritis ⑤ inflammatory bowel disease; Sacroiliac joint imaging changes means: bilateral grade 2-4, unilateral grade 3-4 changes, or active sacroiliac arthritis manifestation on nuclear magnetic (MRI) according to the revised New York criteria. Application of spondyloarthritis (SpA) classification criteria: low back pain of unknown origin for more than 3 months, age of onset under 45 years, with or without peripheral joint manifestations, all use the classification criteria for medial spondyloarthritis. If only peripheral arthritis is present, the classification criteria for peripheral spondyloarthritis are used. The medial plus the peripheral are combined to form a universal classification of spondyloarthritis.