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risk factors may have implications not only for treatment planning but also for the prevention of these conditions in daily clinical practice.
Classification criteria
As for every rheumatological disease, diagnostic criteria for SpA are lacking. Different sets of criteria have been proposed for the classification of SpA (that means: to be applied in patients with a diagnosis of SpA). According to the modified New York criteria, the presence of radiographic sacroiliitis (grade 2 bilateral or grade 3-4 unilaterally) in combination with one of the clinical criteria
(low back pain or limitation of the lumbar spine or limitation of chest expansion), is mandatory in order to classify a patient as having AS7. The European Spondylarthropathy Study Group (ESSG)-
criteria 8 and the Amor-criteria9 were the first aiming at classifying patients along the whole disease spectrum. The entry-criterion of the ESSG criteria is the presence of IBP or peripheral arthritis. Patients with one of these entry criteria in combination with one minor criterion are classified as SpA according to the ESSG criteria. In contrast, in the Amor criteria a list of signs are included and none of them is required for classifying a patient as having SpA. In 2009 ASAS has proposed two
classification criteria sets for SpA. One set can be applied in patients that have presented with predominantly axial involvement (axSpA)10, and the other set can be applied in patients that have presented with predominantly peripheral involvement (pSpA)11. The axSpA-criteria can be applied
in patients that have presented with chronic back pain (≥3 months) starting before the age of 45 years. This set consist of two arms: the imaging arm and the clinical arm. Patients can be classified in the imaging arm when one SpA-feature is present in addition to sacroiliitis on radiographs or magnetic resonance imaging (MRI). Patients can be classified according to the clinical arm if two
SpA features are present in addition to HLA-B27 positivity. The pSpA criteria can be applied in patients that have presented with at least one of the peripheral manifestations arthritis, enthesitis
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