Maksymowych et al developed the Edmonton Ankylosing Metrology Index (EDASMI) for evaluating patients with ankylosing spondylitis. This is a simple 4-item measure of spinal, chest and hip mobility that can be used to monitor a patient's response to therapy. The authors are from the University of Alberta in Edmonton, CAYRE Arthritis and Rehabilitation Clinic in Bogata, and James Cook University in Queensland, Australia.
Parameters:
(1) cervical rotation (The distance from the suprasternal notch to the right tragus is measured with the person looking ahead. It is then measured after rotating the head towards the right shoulder as far as possible. The recording for the right side is the difference between these 2 measurements. This is repeated on the left side. The final value is the sum of the left and right recordings.)
(2) chest expansion in cm (difference in chest circumference between maximum inhalation and maximum exhalation at the level of the xiphisternum)
(3) lateral lumbar flexion (The person stands straight with the arms at the side. The thigh is marked at the level of the tip of the middle finger on the left or right side. The person is then instructed to bend laterally as much as possible and the position of the middle finger's tip is again marked. The measurement on each side is the distance between these 2 marks. The recorded value is the average of the readings on the left and right sides.)
(4) internal rotation of the hip (The person sits on an examination table with knees together and flexed at 90 degrees. A piece of paper is placed between the knees. the person is instructed to rotate both feet outward simultaneously while keeping the piece of paper suspended. The recorded reading is the distance between the medial malleoli in centimeters at the point of maximal rotation.)
|
Parameter |
Finding |
Points |
|
cervical rotation |
>= 80th percentile |
0 |
|
|
60 - 79th percentile |
1 |
|
|
40 - 59th percentile |
2 |
|
|
20 - 39th percentile |
3 |
|
|
< 20th percentile |
4 |
|
chest expansion |
>= 80th percentile |
0 |
|
|
60 - 79th percentile |
1 |
|
|
40 - 59th percentile |
2 |
|
|
20 - 39th percentile |
3 |
|
|
< 20th percentile |
4 |
|
lateral lumbar flexion |
>= 80th percentile |
0 |
|
|
60 - 79th percentile |
1 |
|
|
40 - 59th percentile |
2 |
|
|
20 - 39th percentile |
3 |
|
|
< 20th percentile |
4 |
|
internal rotation of hip |
>= 80th percentile |
0 |
|
|
60 - 79th percentile |
1 |
|
|
40 - 59th percentile |
2 |
|
|
20 - 39th percentile |
3 |
|
|
< 20th percentile |
4 |
|
Parameter |
Finding |
Points |
|
cervical rotation |
>= 4 cm |
0 |
|
|
2.8 - 3.9 cm |
1 |
|
|
2.0 - 2.7 cm |
2 |
|
|
1.4 - 1.9 cm |
3 |
|
|
< 1.4 cm |
4 |
|
chest expansion |
>= 6 cm |
0 |
|
|
4.5 - 5.9 cm |
1 |
|
|
3.0 - 4.4 cm |
2 |
|
|
2.3 - 2.9 cm |
3 |
|
|
< 2.3 cm |
4 |
|
lateral lumbar flexion |
>= 18 cm |
0 |
|
|
13.8 - 17.9 |
1 |
|
|
10.2 - 13.7 |
2 |
|
|
5.7 - 10.1 |
3 |
|
|
< 5.7 cm |
4 |
|
internal rotation of hip |
>= 47 cm |
0 |
|
|
42 - 46.9 cm |
1 |
|
|
36 - 41.9 cm |
2 |
|
|
27 - 35.9 cm |
3 |
|
|
< 27 cm |
4 |
from Table 2, page 579
where:
• Each measure is scored based on the cumulative distribution in the target population. Scoring is not done based on the normal distribution.
• It appears that the distribution is based on people with ankylosing spondylitis in the study population rather than a control population without disease.
total index =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 16
• The higher the score the more severe the ankylosing spondylitis.
• Appropriate therapy is indicated by a significant decrease in the index reflecting improvement in joint mobility.
Performance:
• The method was validated by the authors in patients from Canada, Australia and Columbia. It was found to be simple and reliable.
Purpose: To evaluate a patient with ankylosing spondylitis using the Edmonton Anklyosing Spondylitis Metrology Index (EDASMI).
Specialty: Immunology/Rheumatology
Objective: criteria for diagnosis, severity, prognosis, stage, response to therapy
ICD-10: M45, M08.1,
