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    ASAS Criteria for Axial Spondyloarthritis (SpA)

    Diagnoses axial spondyloarthritis according to Assessment of Spondyloarthritis International Society (ASAS) criteria.
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    When to Use

    Patients with lower back pain in whom spondyloarthritis is in the differential diagnosis.

    Entry Criterion

    Diagnostic Result:

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    Next Steps
    Evidence
    Creator Insights

    Management

    Strong recommendations for patients with axial SpA from the American College of Rheumatology (ACR) include:

    • Use of NSAIDs.
    • Use of TNF inhibitors if activity persists despite NSAIDs.
    • Avoid using systemic glucocorticoids.
    • Physical therapy.
    • Hip arthroplasty for patients with advanced hip arthritis.

    Formula

    Entry criterion:

    Back pain ≥3 months and age at onset <45 years

    Required criteria:

    Sacroiliitis on imaging* plus ≥1 SpA feature, or

    HLA-B27 plus ≥2 additional SpA features

    SpA features:

    • Inflammatory back pain
    • Arthritis
    • Enthesitis (heel)
    • Uveitis
    • Dactylitis
    • Psoriasis
    • Crohn’s disease or ulcerative colitis
    • Good response to NSAIDs
    • Family history of SpA
    • HLA-B27
    • Elevated CRP

    *Active (acute) inflammation on MRI highly suggestive of SpA-associated sacroiliitis, or definite radiographic sacroiliitis according to modified New York criteria (bilateral grade 2-4 sacroiliitis or unilateral grade 3-4 sacroiliitis, Van Der Linden 1984).

    Literature

    Dr. Martin Rudwaleit

    About the Creator

    Martin Rudwaleit, MD, is a rheumatologist at University Hospital Charité, Campus Benjamin Franklin, in Berlin, Germany. He is the principal coordinator of the German Spondyloarthritis Inception Cohort, a prospective longitudinal study on early spondyloarthritis. Dr. Rudwaleit's research interests include clinical aspects of ankylosing spondylitis and other spondyloarthritides.

    To view Dr. Martin Rudwaleit's publications, visit PubMed