Skip to Main Content
Home Books Harrison's Manual of Medicine, 20e

Chapter 163: The Spondyloarthritides

  • Sections
  • Print
  • Get Citation

    Citation

    Disclaimer: These citations have been automatically generated based on the information we have and it may not be 100% accurate. Please consult the latest official manual style if you have any questions regarding the format accuracy.

    AMA Citation
    The Spondyloarthritides. In: Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L., & Longo D.L., & Loscalzo J(Eds.),Eds. J. Larry Jameson, et al.eds. Harrison's Manual of Medicine, 20e. McGraw-Hill; Accessed August 07, 2020. https://accessmedicine.mhmedical.com/content.aspx?bookid=2738&sectionid=227559319
    APA Citation
    The spondyloarthritides. Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L., & Longo D.L., & Loscalzo J(Eds.),Eds. J. Larry Jameson, et al. (2020). Harrison's Manual of Medicine, 20e. McGraw-Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2738&sectionid=227559319
    MLA Citation
    "The Spondyloarthritides." Harrison's Manual of Medicine, 20e Jameson J, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J. Jameson J, & Fauci A.S., & Kasper D.L., & Hauser S.L., & Longo D.L., & Loscalzo J(Eds.),Eds. J. Larry Jameson, et al. McGraw-Hill, 2020, https://accessmedicine.mhmedical.com/content.aspx?bookid=2738&sectionid=227559319.

    Download citation file:

    RIS (Zotero)
    EndNote
    BibTex
    Medlars
    ProCite
    RefWorks
    Reference Manager
    Mendeley
    © Copyright
  • Tools
  • Search Book
  • Clip
Top

INTRODUCTION

DEFINITION

The spondyloarthritides (SpA) are a family of diseases that include ankylosing spondylitis (AS), reactive arthritis (ReA), psoriatic arthritis (PsA), enteropathic arthritis, juvenile-onset SpA, and undifferentiated SpA. More recently, these disorders have been broadly classified as predominantly axial SpA, affecting the spine, pelvis, and thoracic cage, or predominantly peripheral SpA, affecting the extremities. Classification criteria based on these main clinical features have been developed that aide in early identification (Tables 163-1 and 163-2).

TABLE 163-1ASAS Criteria for Classification of Axial Spondyloarthritis (To Be Applied for Pts with Back Pain ≥3 Months and Age of Onset <45 Years)a
View Table|Favorite Table|Download (.pdf)
TABLE 163-1 ASAS Criteria for Classification of Axial Spondyloarthritis (To Be Applied for Pts with Back Pain ≥3 Months and Age of Onset <45 Years)a
SACROILIITIS ON IMAGING PLUS ≥1 SPA FEATURE OR HLA-B27 PLUS ≥2 OTHER SPA FEATURES

Sacroiliitis on imaging

  • Active (acute) inflammation on MRI highly suggestive of SpA-associated sacroiliitisb

    and/or

  • Definite radiographic sacroiliitis according to modified New York criteriac

  

SpA features

  • Inflammatory back paind

  • Arthritise

  • Enthesitis (heel)f

  • Anterior uveitisg

  • Dactylitise

  • Psoriasise

  • Crohn’s disease or ulcerative colitise

  • Good response to NSAIDsh

  • Family history of SpAi

  • HLA-B27

  • Elevated CRPj

aSensitivity 83%, specificity 84%. The imaging arm (sacroiliitis) alone has a sensitivity of 66% and a specificity of 97%.

bBone marrow edema and/or osteitis on short tau inversion recovery (STIR) or gadolinium-enhanced T1 image.

cBilateral grade ≥2 or unilateral grade 3 or 4.

dSee text for criteria.

ePast or present, diagnosed by a physician.

fPast or present pain or tenderness on examination at calcaneus insertion of Achilles tendon or plantar fascia.

gPast or present, confirmed by an ophthalmologist.

hSubstantial relief of back pain at 24–48 h after a full dose of NSAID.

iFirst- or second-degree relatives with ankylosing spondylitis (AS), psoriasis, uveitis, reactive arthritis (ReA), or inflammatory bowel disease (IBD).

jAfter exclusion of other causes of elevated CRP.

Abbreviations: ASAS, Assessment of Spondyloarthritis International Society; CRP, C-reactive protein; MRI, magnetic resonance imaging; NSAIDs, nonsteroidal anti-inflammatory drugs; SpA, spondyloarthritis.

Source: Rudwaleit M et al: The development of assessment of spondyloarthritis international society classification criteria for axial spondyloarthritis (part II). Ann Rheum Dis 68:777, 2009. Adapted by permission from BMJ Publishing Group Limited.

TABLE 163-2ASAS Criteria for Peripheral Spondyloarthritisa
View Table|Favorite Table|Download (.pdf)
TABLE 163-2 ASAS Criteria for Peripheral Spondyloarthritisa
Arthritisb Or Enthesitis Or Dactylitis

PLUS EITHER

One or more of the following SpA features:

  • Psoriasis

  • Crohn’s disease or ulcerative colitis

  • Preceding infection

  • Uveitis

  • HLA-B27

  • Sacroiliitis on imaging (radiographs or MRI)

OR two or more of the following SpA features:

  • Arthritis

  • Enthesitis

  • Dactylitis

  • Inflammatory back pain ever

  • Family history for SpA

aSensitivity 78%, specificity 82%.

b...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MHE Privacy Center Close