Skip to main content

Advertisement

Log in

Diagnosing early ankylosing spondylitis

  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Diagnosis of ankylosing spondylitis is still delayed by many years. Several efforts have been made in the past few years to shorten this delay. A new set of criteria for inflammatory back pain has performed better than previous sets. MRI has evolved to become the standard imaging modality for the detection of sacroiliitis during early disease, and it clearly outperforms quantitative scintigraphy, which was the standard screening test for many years. Promising new developments such as whole body MRI and ultrasound (sonography) for the detection of enthesitis or sacroiliitis deserve further evaluation. Serum antibodies directed against a 28-kD Drosophila antigen may provide additional diagnostic information. A recently proposed diagnostic algorithm in patients with suspected early ankylosing spondylitis may help physicians confidently diagnose patients before definite radiographic sacroiliitis is detectable. Finally, referral strategies for patients seen by primary care physicians seem to work well and are currently under further valuation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Sieper J, Rudwaleit M, Khan MA, Braun J: Concepts and epidemiology of spondyloarthritis. Best Pract Res Clin Rheumatol 2006, 20:401–417.

    Article  PubMed  Google Scholar 

  2. 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):361–368.

    Article  PubMed  Google Scholar 

  3. Bakland G, Nossent HC, Gran JT: Incidence and prevalence of ankylosing spondylitis in Northern Norway. Arthritis Rheum 2005, 53:850–855.

    Article  PubMed  Google Scholar 

  4. Trontzas P, Andrianakos A, Miyakis S, et al.: Seronegative spondyloarthropathies in Greece: a population-based study of prevalence, clinical pattern, and management. The ESORDIG study. Clin Rheumatol 2005, 24:583–589.

    Article  PubMed  CAS  Google Scholar 

  5. Mau W, Zeidler H, Mau R, et al.: Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 1988, 15:1109–1114.

    PubMed  CAS  Google Scholar 

  6. Feldtkeller E, Khan MA, van der Heijde D, et al.: Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 2003, 23:61–66.

    PubMed  Google Scholar 

  7. Rudwaleit M, Khan MA, Sieper J: The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 2005, 52:1000–1008.

    Article  PubMed  Google Scholar 

  8. Rudwaleit M, Listing J, Märker-Hermann E, et al.: The burden of disease in patients with ankylosing spondylitis (AS) and pre-radiographic axial spondyloarthritis. Arthritis Rheum 2004, 50(Suppl):S211.

    Google Scholar 

  9. Rudwaleit M, Listing J, Brandt J, et al.: Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis 2004, 63:665–670.

    Article  PubMed  CAS  Google Scholar 

  10. Dougados M, van der Linden S, Juhlin R, et al.: The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 1991, 34:1218–1227.

    Article  PubMed  CAS  Google Scholar 

  11. Amor B, Dougados M, Listrat V, et al.: Evaluation of the Amor criteria for spondylarthropathies and European Spondylarthropathy Study Group (ESSG). A cross-sectional analysis of 2,228 patients [in French]. Ann Med Interne (Paris) 1991, 142:85–89.

    CAS  Google Scholar 

  12. Calin A, Porta J, Fries JF, Schurman DJ: Clinical history as a screening test for ankylosing spondylitis. JAMA 1977, 237:2613–2614.

    Article  PubMed  CAS  Google Scholar 

  13. Rudwaleit M, Metter A, Listing J, et al.: Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 2006, 54:569–578.

    Article  PubMed  Google Scholar 

  14. Rudwaleit M, van der Heijde D, Khan MA, et al.: How to diagnose axial spondyloarthritis early. Ann Rheum Dis 2004, 63:535–543.

    Article  PubMed  CAS  Google Scholar 

  15. Rudwaleit M, Wenz J, Vahldiek J, et al.: Evaluation of the diagnostic algorithm and the probability approach (likelihood ratio product) in diagnosing patients with early ankylosing spondylitis. Arthritis Rheum 2006, 54(Suppl):S468.

    Google Scholar 

  16. Underwood MR, Dawes P: Inflammatory back pain in primary care. Br J Rheumatol 1995, 34:1074–1077.

    Article  PubMed  CAS  Google Scholar 

  17. Rudwaleit M, Feldtkeller E, Sieper J: Easy assessment of axial spondyloarthritis (early ankylosing spondylitis) at the bedside. Ann Rheum Dis 2006, 65:1251–1252.

    Article  PubMed  CAS  Google Scholar 

  18. Lakomek HJ, Will H, Zech M, Kruskemper HL: A new serologic marker in ankylosing spondylitis. Arthritis Rheum 1984, 27:961–967.

    Article  PubMed  CAS  Google Scholar 

  19. Lakomek HJ, Schwochau M, Decken K, et al.: Attempts towards a serological diagnosis of ankylosing spondylitis. Clin Rheumatol 1987, 6(Suppl 2):67–72.

    Article  PubMed  Google Scholar 

  20. Duftner C, Dejaco C, Klauser A, et al.: High positive predictive value of specific antibodies cross-reacting with a 28-kDa Drosophila antigen for diagnosis of ankylosing spondylitis. Rheumatology (Oxford) 2006, 45:38–42.

    Article  CAS  Google Scholar 

  21. Rudwaleit M, Sieper J: Positive and negative predictive values from published studies can be misleading for decision-making in clinical practice. Rheumatology (Oxford) 2006, 45:779–780; author reply 780–771.

    Article  CAS  Google Scholar 

  22. Inanc N, Atagunduz P, Sen F, et al.: The investigation of sacroiliitis with different imaging techniques in spondyloarthropathies. Rheumatol Int 2005, 25:591–594.

    Article  PubMed  CAS  Google Scholar 

  23. Marc V, Dromer C, Le Guennec P, et al.: Magnetic resonance imaging and axial involvement in spondylarthropathies. Delineation of the spinal entheses. Rev Rhum Engl Ed 1997, 64:465–473.

    PubMed  CAS  Google Scholar 

  24. Jee WH, McCauley TR, Lee SH, et al.: Sacroiliitis in patients with ankylosing spondylitis: association of MR findings with disease activity. Magn Reson Imaging 2004, 22:245–250.

    Article  PubMed  Google Scholar 

  25. Unlu E, Pamuk ON, Cakir N: Color and duplex Doppler sonography to detect sacroiliitis and spinal inflammation in ankylosing spondylitis. Can this method reveal response to anti-tumor necrosis factor therapy? J Rheumatol 2007, 34:110–116.

    PubMed  Google Scholar 

  26. Arslan H, Sakarya ME, Adak B, et al.: Duplex and color Doppler sonographic findings in active sacroiliitis. AJR Am J Roentgenol 1999, 173:677–680.

    PubMed  CAS  Google Scholar 

  27. Klauser A, Halpern EJ, Frauscher F, et al.: Inflammatory low back pain: high negative predictive value of contrast-enhanced color Doppler ultrasound in the detection of inflamed sacroiliac joints. Arthritis Rheum 2005, 53:440–444.

    Article  PubMed  Google Scholar 

  28. Kiris A, Kaya A, Ozgocmen S, Kocakoc E: Assessment of enthesitis in ankylosing spondylitis by power Doppler ultrasonography. Skeletal Radiol 2006, 35:522–528.

    Article  PubMed  Google Scholar 

  29. Heuft-Dorenbosch L, Spoorenberg A, van Tubergen A, et al.: Assessment of enthesitis in ankylosing spondylitis. Ann Rheum Dis 2003, 62:127–132.

    Article  PubMed  CAS  Google Scholar 

  30. Althoff CE, Appel H, Rudwaleit M, et al.: Whole-body MRI as a new screening tool for detecting axial and peripheral manifestations of spondyloarthritis. Ann Rheum Dis 2007, 66:983–985.

    Article  PubMed  CAS  Google Scholar 

  31. Weber U, Pfirrmann CW, Kissling RO, et al.: Whole body MR imaging in ankylosing spondylitis: a descriptive pilot study in patients with suspected early and active confirmed ankylosing spondylitis. BMC Musculoskelet Disord 2007, 8:20.

    Article  PubMed  Google Scholar 

  32. Sieper J, Rudwaleit M: Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 2005, 64:659–663.

    Article  PubMed  CAS  Google Scholar 

  33. Brandt HC, Spiller I, Song IH, et al.: Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritis. Ann Rheum Dis 2007, Epub ahead of print.

  34. Heuft-Dorenbosch L, Landewe R, Weijers R, et al.: Performance of various criteria sets in patients with inflammatory back pain of short duration; the Maastricht early spondyloarthritis clinic. Ann Rheum Dis 2007, 66:92–98.

    Article  PubMed  CAS  Google Scholar 

  35. Amor B, Dougados M, Listrat V, et al.: Are classification criteria for spondylarthropathy useful as diagnostic criteria? Rev Rhum Engl Ed 1995, 62:10–15.

    PubMed  CAS  Google Scholar 

  36. Heuft-Dorenbosch L, Landewe R, Weijers R, et al.: Combining information obtained from magnetic resonance imaging and conventional radiographs to detect sacroiliitis in patients with recent onset inflammatory back pain. Ann Rheum Dis 2006, 65:804–808.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Martin Rudwaleit.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Song, IH., Sieper, J. & Rudwaleit, M. Diagnosing early ankylosing spondylitis. Curr Rheumatol Rep 9, 367–374 (2007). https://doi.org/10.1007/s11926-007-0059-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11926-007-0059-1

Keywords

Navigation