Spondyloarthropathies
The European Spondyloarthropathy Study
Group (ESSG) criteria for classifying disease as a
spondyloarthropathy.
Spondyloarthropathy is defined as the presence of inflammatory spinal pain or synovitis and
one or more of the following:
• family history: presence, in first- or second-degree relatives, of: ankylosing spondylitis, psoriasis, acute iritis, reactive arthritis, or inflammatory bowel disease.
• psoriasis
• inflammatory bowel disease
• alternating buttock pain
• enthesitis
• acute diarrhea
• urethritis
• sacroiliitis: bilateral grade 2–4 or unilateral grade 3–4
Definitions used in these criteria
Inflammatory spinal pain: history of or current symptoms of spinal pain (low, mid and upper back, or neck region), with at least four of the following five components:
a at least 3 months duration
b onset before age 45
c insidious (gradual) onset
d improved by exercise
e associated with morning spinal stiffness
Synovitis: past or present asymmetric arthritis, or arthritis predominately in the lower limbs
Psoriasis: past or present psoriasis diagnosed by a doctor
Inflammatory bowel disease: past or present ulcerative colitis or
Crohn’s disease diagnosed by a doctor and confirmed by radiographic examination or endoscopy
Alternating buttock pain: past or present pain alternating between the two buttock regions
Enthesitis: past or present spontaneous pain or tenderness at exami-
nation of the site of the insertion of the Achilles tendon or plantar fascia
Acute diarrhea: episode of diarrhea occurring within 1 month before arthritis onset
Urethritis: nongonococcal urethritis or cervicitis occurring within 1 month before arthritis onset
Sacroiliitis grading system: 0 = normal, 1 = possible, 2 = minimal,
3 = moderate, 4 = completely fused (ankylosed)
