Clinical and Radiological Presentations of Late-Onset Spondyloarthritis

Table 1

ASAS criteria for axial spondyloarthropathy [9].

Back pain ≥3 months and age <45 years ET
Sacroiliitis by MRI or radiography* + 1 other feature	OR	HLA B27 + 2 other features
Features of axial SpA
Inflammatory back pain	4 of the 5 following characteristics
	Age <40 years
	Insidious onset
	Improvement with exercise
	No improvement with rest
	Pain at night
Arthritis	Past or present active synovitis diagnosed by a physician
Enthesitis	Pain spontaneously or upon palpation of the Achilles tendon insertion site or plantar fascia
Uveitis	Past or present anterior uveitis diagnosed by a physician
Dactylitis	Past or present active dactylitis diagnosed by a physician
Psoriasis	Past or present active psoriasis diagnosed by a physician
Crohn's disease/ulcerative colitis	Past or present, diagnosed by a physician
Good response to NSAIDs	24–48 h after the initiation of full-dose NSAID therapy, the pain is gone or much better
Family history for SpA	First- or second-degree relative with any of the following: SpA, psoriasis, acute uveitis, reactive arthritis, chronic inflammatory bowel disease
HLA-B27	Presence of B27
Elevated CRP	CRP above the upper limit of the normal range, in the absence of another cause of CRP elevation

∗Sacroiliitis (X-rays or MRI): Definite radiographic sacroiliitis (grade 2 bilaterally or grade 3-4 unilaterally; according to modified New York criteria 1984) Or—active (acute) inflammation of sacroiliac joints on MRI, highly suggestive of sacroiliitis associated with spondyloarthritis.