Early diagnostic criteria of ankylosing spondylitis.
| Criteria | Points | |
| Genetic factors | HLA-B27 positive | 1,5 |
| Clinical factors | Pain in the spine, sciatic area, heel pain. | 1 |
| Positive Mennell’s sign – jerky hyperextension of the extended leg of the patient, lying in prone or lateral position, in the sacroiliac joint (ISG). If pain is indicated, this is called a positive Mennell’s sign (= sacroiliitis/inflammatory, destructive change in the joints between the sacrum and ilium). A negative sign does not rule out damage to the sacroiliac joint. | 1 | |
| Breathing width ↓, chest pain | 1 | |
| Arthritis (inflammation of the joints, peripheral) | 1 | |
| Uveitis anterior (inflammation of the anterior region of the uvea (middle eye skin), especially the iris (iris) and ciliary muscle) | 1 | |
| limited spinal mobility | 1 | |
| Laboratory Diagnostics | ESR (erythrocyte sedimentation rate) ↑ | 1 |
| X-ray diagnostics | Diagnostic signs such as syndesmophytes (bony protrusions that remodel the outer edge of the intervertebral discs; limit mobility), spinal lesions, arthritis of the small vertebral joints | 1 |
Assessment:
- From 3.5 points, the diagnosis of ankylosing spondylitis is established.
Clinical criteria according to the New York criteria
Ankylosing spondylosis can be classified by the following clinical criteria according to the New York criteria:
- Markedly limited mobility of the lumbar spine in all planes.
- Early/current pain in the area of the dorsolumbar transition/lumbar spine.
- Restriction of respiratory width at the level of the fourth intercostal space.
The diagnosis of ankylosing spondylitis is certain if the following factors are present:
- Bilateral sacroiliitis grade 3/4 + a clinical criterion.
- Bilateral sacroiliitis Gard 2/unilateral sacroiliitis grade 3/4 + criterion 1/criterion 2 + 3.
If only sacroiliitis grade 3 or 4 is present, ankylosing spondylitis is likely.
In the radiograph, one can make the following subdivision of sacroiliitis.
| Stage | Description |
| Degree 0 | normal radiographic findings |
| Grade 1 | On radiographic findings, washed-out joint space, moderate sclerosis (calcification), pseudodilatation |
| Grade 2 | So-called “pearl cord pattern” with joint space widening, marked sclerosis, erosions (defect that affects only the epithelium and does not penetrate into deeper tissue layers) |
| Grade 3 | Joint space narrowing and widening, erosions. |
| Grade 4 | Sclerosis, ankylosis (joint stiffening). |
