Mau et al developed diagnostic criteria for identifying patients with early ankylosing spondylitis. This can help identify patients when aggressive management may reduce long-term disability. The authors are from Medizinische Hochschule Hannover, Agnes-Karll-Krankenhaus Laatzen and Zentralkrankenhaus St. Jurgensstrasse Bremen.
Exclusion criteria:
(1) traumatic, degenerative or noninflammatory spine disease
(2) psoriasis
(3) reactive arthritis
(4) malignancy
(5) infection
(6) metabolic or endocrine disease
(7) other causes for an elevated ESR
(8) positive rheumatoid factor
(9) well-developed signs of ankylosing spondylitis (unequivocal sacroiliitis >= Grade 2)
Parameters:
(1) HLA B27
(2) spinal pain, inflammatory type
(3) lower back pain
(4) thoracic pain or limited chest expansion
(5) peripheral arthritis or heel pain
(6) anterior uveitis
(7) motion of the cervical or lumbar spine
(8) erythrocyte sedimentation rate (ESR)
(9) radiographic findings in the spine
|
Parameter
|
Finding
|
Points
|
|
HLA B27
|
absent
|
0
|
|
|
present
|
1.5
|
|
spinal pain, inflammatory type
|
absent
|
0
|
|
|
present
|
1
|
|
lower back pain
|
absent
|
0
|
|
|
present
|
1
|
|
thoracic pain or limited chest expansion
|
absent
|
0
|
|
|
present
|
1
|
|
peripheral arthritis or heel pain
|
absent
|
0
|
|
|
present
|
1
|
|
anterior uveitis
|
absent
|
0
|
|
|
present
|
1
|
|
motion of cervical or lumbar spine
|
normal in both
|
0
|
|
|
limited in all planes in one or both areas
|
1
|
|
ESR
|
normal
|
0
|
|
|
elevated
|
1
|
|
radiologic findings in the spine
|
absent
|
0
|
|
|
present
|
1
|
where:
• Radiologic findings in the spine include (a) syndesmophytes, (b) squaring phenomenon, (c) barrel-shaped vertebrae, (d) Romanus or Andersson lesions, (e) involvement of apophyseal or costovertebral joints.
• An elevated ESR was (a) for male < 50 years > 15 mm per hour, (b) for male >= 50 years > 20 mm per hour, (c) for female < 50 years > 25 mm per hour, (d) for female >=50 years > 30 mm per hour.
• Limited chest expansion is <= 2.5 cm.
• Thoracic pain may be spontaneous or induced by compression.
• Lower back pain radiates to the buttocks or back of the thighs; it may be spontaneous or induced by stretching the sacroiliac joints.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 9.5
• A score >= 3.5 indicated early ankylosing spondylitis
