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Diagnosing axial spondyloarthropathy. The new Assessment in SpondyloArthritis international Society criteria: MRI entering centre stage
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  1. A N Bennett2,
  2. H Marzo-Ortega1,
  3. P Emery1,
  4. D McGonagle1
  1. 1
    Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
  2. 2
    Defence Medical Rehabilitation Centre, Headley Court, Epsom, Surrey KT18 6JN, UK
  1. Professor P Emery, Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, Clinical Director (Rheumatology), Director-Leeds MSK Biomedical Research Unit, Chapel Allerton Hospital, Chapel Town Road, Leeds LS7 4SA, UK; p.emery{at}leeds.ac.uk

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In this issue of the Annals of Rheumatic Disease the Assessment in SpondyloArthritis international Society (ASAS) have published three interrelated papers (see pages 770, 777 and 784)13 that could contribute to a new era in the diagnosis and classification of axial spondyloathritis (SpA). The first paper focuses on a new definition of inflammatory back pain (IBP), the “expert” criteria, followed by two reports on the development of new classification criteria for axial SpA and their validation in a large multicentre study. These criteria for axial SpA will be welcomed by the spondyloarthropathy community, since the currently available criteria46 do not allow for the diagnosis of preradiographic axial SpA. The proposed new set of criteria includes early (preradiographic) and established ankylosing spondylitis (AS), recognising them as a continuum of disease. This is of major importance as it is now clear that the burden of early AS is comparable to that of the later stages.7 The benefit of MRI in the diagnosis of early axial SpA is recognised by the authors and included in the new classification criteria. Indeed, the inclusion of MRI is the most significant change compared to previous criteria46 and is in line with clinical experience where MRI is of recognised value as a diagnostic and outcome tool.8 9 14 Furthermore, with the emerging data on the efficacy of tumour necrosis factor (TNF)α blocking therapies in early disease10 11 a new horizon has opened whereby AS sufferers can be identified and treated in the early stages of their disease process before structural damage has occurred.

In the first report Sieper et al1 propose new clinical criteria for IBP. The study adopted a novel approach in which the “experts” were blinded to patient diagnosis, and …

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