Here is a posting by Evelyn (which again I have shamelessly lifted

that gives the various criteria for a DX of spondylarthropy/AS. What many women get for years is something called undifferentiated spondylarthropy, as women tend to fuse later in life than men, and it is often not DXed correctly simply because rheumies are not looking for it. You might copy this and take it with you,or make your own list, not suggest a DX to the doc but if the criteria fit, then list it, at the very least it will help separate out the docs from the quacks.
The term spondyloarthropathy is an umbrella term for a family of conditions which includes ankylosing spondylitis, certain forms of psoriatic arthritis, enteropathic arthritis (arthritis associated with inflammatory bowel disease), reactive arthritis/Reiter's syndrome (arthritis associated with a known or likely preceding infection of the genitourinary tract or the intestinal tract) and "undifferentiated' spondyloarthropathy.
There are two sets of established criteria in the medical literature for the diagnosis of ankylosing spondylitis. These are the ROME criteria and the NEW YORK criteria. For the definite diagnosis of ankylosing spondylitis according to established criteria, there generally needs to be evidence of sacroiliac/spine changes on xray exam. Changes to the xray exam may not occur until relatively late in the disease process, so early AS may not be found by these "AS" criteria.
There are also criteria for the diagnosis of spondyloarthropathy that do not necessarily require evidence for changes on xray. Again there are two sets of established criteria in the medical literature for the diagnosis of spondyloarthropathy. These are the ESSG criteria (European Spondyloarthropathy Study Group) and the AMOR criteria. So someone with early AS can be given a diagnosis of spondyloarthropathy which may then evolve into definite AS in later years. If a person with spondyloarthropathy has associated psoriasis, then they have psoriatic arthritis. If a person with spondyloarthropathy has associated inflammatory bowel disease such as Crohn's disease or ulcerative colitis, then they have enteropathic arthritis. If a person with spondyloarthropathy has good evidence of known or likely preceding infection just prior to the onset of joint pain, then they have reactive arthritis/Reiter's. If a person with spondyloarthropathy does not have features of psoriasis, inflammatory bowel disease, or evidence of preceding urinary tract or intestinal tract infection, then they would have undifferentiated spondyloarthropathy. ANY OF THESE SPONDYLOARTHROPATHIES CAN EVOLVE INTO AS, BUT DO NOT ALWAYS DO SO.
ROME criteria FOR ANKYLOSING SPONDYLITIS:
Rome criteria (1961): Diagnosis of AS when any clinical criteria present with bilateral sacroiliitis [by X-ray] grade 2 or higher
1. Low back pain and stiffness for >3 months which is not relieved by rest
2. Pain and stiffness in the thoracic region
3. Limited motion in the lumbar spine
4. Limited chest expansion
5. History of uveitis
Rome criteria from:
http://www.emedicine.com/med/topic2700.htm#target5
NEW YORK criteria FOR ANKYLOSING SPONDYLITIS:
New York criteria (1984 ): Definite AS when the fourth or fifth criterion mentioned [Xray changes] presents with any clinical criteria:
[A. Clinical criteria]
1. Low back pain with inflammatory characteristics
2. Limitation of lumbar spine motion in sagittal and frontal planes
3. Decreased chest expansion
[B. X-ray criteria]
4. Bilateral sacroiliitis grade 2 or higher [by X-Ray]
5. Unilateral sacroiliitis grade 3 or higher [by X-Ray]
New York criteria found here:
http://www.emedicine.com/med/topic2700.htm#target5
MODIFIED NEW YORK criteria FOR ANKYLOSING SPONDYLITIS
Bilateral sacroiliitis [on xray], grade 2-4, or unilateral sacroiliitis [on xray], grade 3-4 and any one of the following three clinical criteria:
1. Low back pain of at least three months duration improved by exercise and not relieved by rest
2. Limitation of lumbar spine motion in sagittal and frontal planes.
3. Chest expansion decreased relative to normal values for age and sex.
Modified New York criteria found here http://www.medal.org/docs_ch22/doc_ch22.21.html#A22.21.05
ADDITIONAL DESCRIPTION OF criteria FOR DIAGNOSIS OF AS
The diagnostic criteria for ankylosing spondylitis.
1. Limitation of motion of the lumbar spine in all three planes: anterior flexion, lateral flexion, extension.
2. History of pain in the lumbar spine or at the dorso-lumbar junction.
3. Limited chest expansion to 2.5 cm or less, measured at the fourth intercostal line.
4. sacroiliitis on xray of the sacroiliac joints.
The sacroiliitis is graded on radiological criteria:
Grade 0: normal.
Grade 1: suspicious.
Grade 2: minimal abnormality, small areas of erosions or sclerosis, without alteration of joint width.
Grade 3: definite abnormality- moderate or advanced sacroiliitis with irregularity, one or more erosions, evidence of sclerosis. Partial ankylosis
Grade 4: total ankylosis.
Definite ankylosing spondylitis:
Grade 3-4 sacroiliitis with at least one clinical criterion.
Or grade 3-4 unilateral or grade 2 bilateral sacroiliitis, with clinical criterion 1 or criterion 2 and 3.
Probable ankylosing spondylitis: Grade 3-4 sacroiliitis without any clinical criteria.
This set of criteria for AS is from "Drdoc" website:
http://www.arthritis.co.za/ankspond.html
ESSG (EUROPEAN SPONDYLOARTHROPATHY STUDY GROUP) criteria FOR THE DIAGNOSIS OF SPONDYLOARTHROPATHY:
Inflammatory spinal pain OR synovitis, assymetric, predominant in lower limbs AND one of the following:
1. positive family history
2. inflammatory bowel disease
3. urethritis, cervicitis or acute diarrhea within one month before arthritis
4. buttock pain alternating between right and left gluteal areas
5. enthesopathy
6. sacroiliitis
ESSG criteria can be found here:
http://www.emedicine.com/med/topic2700.htm#target4
and here:
http://www3.utsouthwestern.edu/cme/endurmat/lipsky/alg_apdx/app_p.htm See section 2A
AMOR criteria FOR THE DIAGNOSIS OF SPONDYLOARTHROPATHY
A. PAST OR CURRENT CLINICAL MANIFESTATIONS:
1. Back pain at night and/or back stiffness in the morning=one point
2. asymmetric oligoarthritis=two points
3. gluteal pain without other details=one point OR alternating gluteal pain=two points
4. sausage like digit or toe=two points
5. heel pain or other enthesopathy=two points
6. iritis=two points
7. non-gonococcal urethritis or cervicitis within 1 month before the onset of arthritis=one point
8. diarrhea within one month before onset of arthritis=one point
9. past or current psoriasis and/or balanitis and/or inflammatory bowel disease=two points
B. XRAY CHANGES
10. sacroiliitis (stage 2 or above if bilateral, more than stage 2 if unilateral):three points
C. PREDISPOSING GENETIC FACTORS
11. Presence of the HLA B27 antigen and/or positive family history for ankylosing spondylitis: two points
D. RESPONSIVENESS TO TREATMENT
12. Improvement within 48 hours after initiation of a non-steroidal anti-inflammatory drug: one point
Patients with a total score of six points or more are classified as having a spondyloarthropathy.
Amor criteria found in:
http://www.emedicine.com/med/topic2700.htm#target4
and here:
http://www3.utsouthwestern.edu/cme/endurmat/lipsky/alg_apdx/app_p.htm] see section 2B
FLOWCHART FOR DIAGNOSIS OF SPONDYLOARTHROPATHY from MA Khan article:
http://merck.praxis.md/images/cpm/RH/390-03.jpg
from
http://merck.praxis.md/bpm/bpm.asp?page=CPM02RH390§ion=report&ss=2
print version of report:
http://merck.praxis.md/bpm/bpmviewall.asp?page=CPM02RH390
Cheryl

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