Modified New York Criteria
Clinical criteria:
- Low back pain of at least 3 months duration improved by exercise and not relieved by
rest
- Limitation of lumbar spine in sagittal and frontal planes
- Chest expansion decreased relative to normal values for age and sex
Radiographic criterion:
- Unilateral grade 3 or 4 sacroiliitis or bilateral grade 2 sacroiliitis on radiograph
A patient is classified as definite AS if the radiographic criterion is present and at least one
clinical criterion is present.
van der Linden S, Valkenburg HA, Cats A. Evaluation of diagnostic criteria for ankylosing
spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum
1984;27(4):361-8.
Amor Criteria
Lumbar or dorsal pain during the night or morning stiffness of the lumbar or dorsal
spine
Asymmetrical oligoarthritis
Buttock pain
If alternating buttock pain
Sausage-like toe or digit
Heel pain
Iritis
Nongonococcal urethritis or cervicitis accompanying or within 1 month before the
onset of arthritis
Acute diarrhoea accompanying or within 1 month before arthritis onset
Presence or history of psoriasis, balanitis, or inflammatory bowel disease
Radiological sacroiliitis (at least grade 2 bilateral or grade 3 unilateral)
Presence of HLA-B27 or familial history of ankylosing spondylitis, Reiter’s syndrome,
uveitis, psoriasis or inflammatory bowel disease
Clear-cut improvement of rheumatic complaints with NSAIDs in <48 hours or relapse
of pain in <48 hours if NSAIDs are discontinued
1
2
1
2
2
2
2
1
1
2
3
2
2
A patient will be considered as suffering from spondylarthropathy if the sum of the applicable
criteria is at least 6.
Amor B, Dougados M, Listrat V, Menkes CJ, Roux H, Benhamou C, et al. Are classification
criteria for spondylarthropathy useful as diagnostic criteria? Rev Rhum Engl Ed
1995;62(1):10-5.
ESSG Criteria
Inflammatory back pain OR Synovitis (asymmetric or predominantly in lower extremities)
AND
At least one of the following
- positive family history
- psoriasis
- inflammatory bowel disease
- urethritis, cervicitis, or acute diarrhoea within 1 month before onset arthritis
- alternating buttock pain
- enthesiopathy
- sacroiliitis
Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European
Spondylarthropathy Study Group preliminary criteria for the classification of
spondylarthropathy Arthritis Rheum 1991;34:1218-27.
ASAS core set of domains and instruments for signs and symptoms
Domain
Physical function
Recommended instrument
Bath Ankylosing Spondylitis Functional Index (BASFI) a
patient oriented questionnaire of 10 questions that are
averaged to yield a score between 0 and 100
As an alternative the Dougados functional index including
20 questions on a 5-point Likert scale (range 0-40) is
acceptable
Pain
Two separate questions: 1) total pain in the spine due to
AS. 2) pain at night in the spine due to AS
Patient global of disease activity Patient Global-visual analogue scale with 0 being no
disease activity and 100 being severe disease activity.
Spinal mobility
Four instruments:
1) Occiput to wall distance
2) Chest expansion
3) Modified Schober index
4) Lateral lumbar flexion or Bath Ankylosing Spondylitis
Metrology Index (BASMI)*
Inflammation (spinal stiffness) Average of morning stiffness duration and intensity (e.g.
Bath Ankylosing Spondylitis Disease Activity Index
(BASDAI) questions 5 and 6) or duration of morning
stiffness only
Fatigue*
Fatigue question from the BASDAI
*added in an update of the core set (ASAS workshop Gent, Oct 2002)
van der Heijde D, Calin A, Dougados M, Khan A, van der Linden Sj, Bellamy N. Selection of
instruments in the core set for DC-ART, SM-ARD, physical therapy, and clinical record
keeping in AS. Progress report of ASAS working group. J Rheumatol 1999;26:951-4