Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group AS Rating System - Stage 1 to Stage 4

I have never heard of it as stages of AS. Only a grading of damage to the SI's as a means of qualifying for Biologic treatment.
You need grade 3 unilateral or grade 2 bilateral to qualify in Australia. But that is all my rheumy uses the scale for. He gave me my diagnosis based on my symptoms and Blood tests and old x-rays of my spine.

It was only later that he did an x-ray of my SI so that I could start biologics.
I guess that is is why some rhuemies are trying to change the rules and gain the right to prescribe Biologics with out the SI grading. Some rhuemies seem to "get" it and others are stuck in the old thinking.

My dr. doesn't use the stages or at least I don't know it. :o) My stage is just painful and tired of it. :o)

The only place I have seen the specific wording you used above (specifically "discrete and wiped aspect of the joint" and "stiffness of the sacroiliac joint" instead of ankylosis or fusion) is this website: http://www.doctortipster.com/1293-ankylosing-spondylitis-symptomatology-diagnosis-and-treatment.html In that article, they were referring to radiological grading of bi-lateral sacroiliitis - necessary in the diagnosis of AS, but not really "stages" of AS. That page from "Dr Tipster" contains some content that is not completely accurate.

A more accurate and widely accepted chart of sacroiliac grading can be found here: http://radiopaedia.org/articles/sacroilitis-grading
grade 0 - normal
grade 1 - some blurring of the joint margins - suspicious
grade 2 - minimal sclerosis with some erosion
grade 3 - definite sclerosis on both sides of the joint
- severe erosions with widening of joint space with or without ankylosis
grade 4 - complete ankylosis - fusion

Bilateral grade 2, or unilateral grade 3 sacroiliitis is still required to meet the formal criteria for an AS diagnosis. Radiographic Sacroiliitis is not necessarily required for a diagnosis of Axial Spondyloarthropathy (a/k/a Undifferentiated Spondylitis) in accordance with the ASAS criteria. There are doctors in the US that will use clinical judgement and call it AS without the radiographic evidence of Sacroiliitis. Usually this is done to facilitate insurance coverage for anti-TNFs.

My Rheumatologist does not generally use the grading terminology in conversations with me, but my medical records do list bi-lateral grade 4 sacroiliitis as do my original x-ray reports from years ago.

I am in the US. I have lived is 3 different states and had 4 Rheumatologists since diagnosis, but I have always made sure my medical records followed me.

If you have a Radiologist's report from your x-rays at diagnosis, it may use the grading scale in the description of your SI joints or it may just use the descriptive terms. Either way, the terminology should be similar to what I linked above. (Personally, I would skip "Dr Tipster" if you are looking for information to bring to your primary care doctor.) If a Rheumatologist did your x-rays there may or may not be a formal report, but it should be summarized in the office note from that day. Two of my kids have now been diagnosed with Spondyloarthropathy. Both of their x-ray and MRI reports use either the Sacroiliitis grading scale or very similar descriptive terms. Neither have full blown AS. Both are diagnosed with Juvenile Spondyloarthropathy which is the pediatric form of Undifferentiated Spondylitis.

**(Just to be clear - the Sacroiliac grading scale I linked is associated with the Modified NY Criteria. It is actively used in the diagnosis of AS. The "Dr Tipster" one is a little off. Rheumatologists may not reference the grading scale much with patients, but that is because it is not really necessary once diagnosis has been made. For instance, my SI joints are both fused. That makes them bilateral grade 4. That will never change. There is not much point in talking about it at future Rheumatology check-ups.