Spondyloarthropathies

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Spondyloarthropathies
European Spondyloarthropathy Study
Group Criteria for helping diagnose the entire
category of Spondyloarthropathies
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Diagnosis of Spondyloarthropathies (1)

• Is there
• Inflammatory arthritis that is asymmetric or
• predominantly lower extremity?
• and/or
• Back pain of insidious onset of gt 3 months
• duration associated with morning stiffness
  and
• improvement with activity?

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Spondylo-arthropathiesInflammatoryArthritis
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Spondyloarthropathies

• Inflammatory back pain--characteristics
• insidious onset before age 40
• persistence for at least 3 months
• accentuation of back pain in A.M.
• or after prolonged rest
• back pain improves with exercise

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Diagnosis of Spondyloarthropathies (1)

• Is there
• Inflammatory arthritis that is asymmetric or
• predominantly lower extremity?
• and/or
• Back pain of insidious onset of gt 3 months
• duration associated with morning stiffness
  and
• improvement with activity?

NO
YES
Unlikely to be a spondyloarthropathy
Is there evidence of psoriasis or inflammatory
bowel disease?
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Diagnosis of Spondyloarthropathies (2)
Is there evidence of psoriasis or inflammatory
bowel disease?
NO
YES

• Consider
• Enteropathic or
• Psoriatic Arthritis

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Spondylo-arthropathies
IBD
Inflammatory bowel disease(IBD)
arthritis
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Spondylo-arthropathies
Psoriatic skin and nail changes
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Diagnosis of Spondyloarthropathies (2)
Is there evidence of psoriasis or inflammatory
bowel disease?
NO
YES

• Is There One or More of the Following
• Radiographic evidence of sacroiliitis?
• Enthesopathy?
• Dactylitis?
• Buttock pain (unilateral or alternating)?
• Family history
• Iritis?
• Acute diarrhea or non-GC urethritis or
• cervicitis within 1 month of arthritis
• onset?

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AsymmetricalSacroiliitisSpondylitis
(Psoriatic orReactive Arthritis)
abnormal
normal
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Symmetrical SacroiliitisAnkylosing Spondylitis
(abnormal)
(abnormal)
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Spondyloarthropathies
Enthesopathy
Erosion
New bone
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Spondylo-arthropathies
Dactylitis
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Spondyloarthropathies
Buttock pain
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Spondyloarthropathies Family History HLA-B27
Disease Associations

• Disease Association
• Ankylosing Spondylitis gt90
• Reactive arthritis 80-85
• Inflammatory bowel 50
• Psoriatic arthritis
• With spondylitis 50
• With peripheral arthritis 15
• Whipples disease 30

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Spondyloarthropathies
Positive family history
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Spondylo-arthropathies
Iritis (Uveitis)

• Likelihood of Iritis
• Disease Percent
• Ank spondylitis 20-30
• Reiters 12-37
• Psor Spondylitis 7-16
• IBD 2-9
• Undiff SA ND

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Spondyloarthropathies
Urethritis or Cervicitis
This is a reminder that acute diarrhea, urethritis
or cervicitis is a criterion But it really
shows circinate balanitis, also a characteristic
of spondyloarthropathies
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Spondyloarthropathies

• Acute diarrhea
• OR
• Non-GC cervicitis
• or urethritis

• Within 1 month of arthritis onset

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Diagnosis of Spondyloarthropathies (3)

• Is There One or More of the Following
• Radiographic evidence of sacroiliitis?
• Enthesopathy?
• Dactylitis?
• Buttock pain (unilateral or alternating)?
• Family history
• Iritis?
• Acute diarrhea or non-GC urethritis or
• cervicitis within 1 month of arthritis
• onset?

NO
YES
Likely to Be a Spondyloarthropathy
Unlikely to Be a Spondyloarthropathy
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Diagnosis of Spondyloarthropathies (4)
Likely to Be a Spondyloarthropathy

• Is there evidence of spondylitis?
• Inflammatory spinal pain and
• limitation of spinal movement?

NO
YES
Probably Reactive Arthritis or Reiters Syndrome
Probably Ankylosing Spondylitis
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Spondyloarthropathies
Probably Reactive Arthritis or Reiters Syndrome
Is there evidence of chlamydial infection? (ie
elevated antichlamydial antibodies)
NO
YES
Chlamydia-Associated Reactive Arthritis
Reactive Arthritis (Reiters Syndrome)
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Spondyloarthropathies ESSG Criteria

• Primary
• Inflammatory Back Pain
• OR
• Synovitis
• Asymmetric
• Predominantly in lower extremities

• Secondary
• Plus one of following
• Psoriasis
• IBD
• Positive family history
• Urethritis, cervicitis, or acute diarrhea within
  1 month of arthritis
• Alternating buttock pain
• Enthesopathy
• Sacroiliitis