NY Criteria Sacroiliitis Grading — SCE Rheumatology MCQ
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Correct answer: E — Bilateral grade 2–4 or unilateral grade 3–4 sacroiliitis
The modified New York radiographic criterion is sacroiliitis of at least grade 2 bilaterally or at least grade 3 unilaterally. Therefore, this patient's bilateral grade 2 changes meet the radiographic threshold. Grade 1 changes are only suspicious and do not qualify. Unilateral grade 2 disease is also insufficient because the unilateral threshold is grade 3. Requiring bilateral grade 3 or grade 4 disease would set the threshold too high. Grade 2 denotes definite but relatively limited structural abnormality, such as small localised erosions or sclerosis without alteration of joint width; grades 3 and 4 represent progressively more advanced disease. Strictly, fulfilment of the complete modified New York classification criteria also requires at least one clinical criterion; the question asks specifically about the radiographic component.
Reference: National Institute for Health and Care Excellence. NG65: Spondyloarthritis in over 16s: diagnosis and management, recommendations 1.2.4–1.2.6. 2017. https://www.nice.org.uk/guidance/NG65/chapter/Recommendations