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ASAS Peripheral SpA Criteria — SCE Rheumatology MCQ

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HardSpondyloarthropathyASAS Peripheral SpA CriteriaSCE Rheumatology

A 30-year-old man has predominantly peripheral symptoms, comprising current asymmetric lower-limb oligoarthritis and clinically confirmed Achilles enthesitis. Three years previously, he had a 4-month episode of inflammatory back pain, which has completely resolved. He has no psoriasis, inflammatory bowel disease, uveitis, preceding infection or family history of spondyloarthritis. HLA-B27 is negative and MRI of the sacroiliac joints is normal. Which statement correctly applies the ASAS peripheral spondyloarthritis classification criteria?

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Correct answer: D — He fulfils them: arthritis provides an entry feature, with enthesitis and previous inflammatory back pain providing two additional SpA features.

The correct answer is D. Current peripheral arthritis, enthesitis or dactylitis supplies the entry manifestation. Classification then requires either one major feature—such as psoriasis, IBD, uveitis, preceding infection, HLA-B27 or imaging sacroiliitis—or at least two other SpA features besides the selected entry manifestation. Using arthritis as the entry feature, this patient has enthesitis and previous inflammatory back pain, satisfying the second arm despite negative HLA-B27 and normal sacroiliac MRI. Arthritis and enthesitis alone would not provide two additional features because the entry manifestation cannot also be counted as an additional feature, so B is incorrect. HLA-B27 and sacroiliitis are not mandatory, excluding C. Previous, rather than necessarily current, inflammatory back pain is recognised, excluding D and E. These are classification criteria and do not replace clinical diagnosis.

Reference: Rudwaleit M et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70:25–31. https://pubmed.ncbi.nlm.nih.gov/21109520/