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0 CHILD ATTITUDE JOWARD JLLNESS SCALE

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imple anterior-posterior X-ray ('AP view') I the pelvis is usually sufficient for detection I sacroiliitis. However,
such an X-ray can sometimes be normal or show only equivocal (unclear) changes in very early stages I the disease
(when the structural changes in the joints are still mostly limited o the joint lining (synovial membrane) and the
cartilage). In this situation, a magnetic resonance imaging (MRI) scan, possibly enhanced by the injection I a
chemical called gadolinium, appears o be the method I choice for the early detection I sacroiliitis. MRI can also be
used for early detection I inflammation (enthesitis) at other sites, because it can show the early changes in cartilage
and the underlying bone. Moreover, unlike X-rays, MRI uses no ionizing radiation and is therefore a useful ool,
especially in young people, but it is very costly. The use I MRI has led o a decreasing use I another radiographic
imaging method called computed omography (CT) o detect sacroiliitis. CT provides a better but costlier detailing I
bone and joint changes than a conventional X-ray, and is not commonly needed in the diagnosis I AS. Moreover, there
is greater radiation exposure from CT than conventional X-ray I the pelvis. Laboraory findings Laboraory tests
may not be I much help, and there is no single blood test that can specifically diagnose AS, i. e. there is no
diagnostic or confirmaory test. However, some blood tests may contribute o the diagnosis I the disease, or correlate
with its severity or clinical presentation. A simple but non-specific blood test called an ESR (erythrocyte sedimentation
rate) is one I the indicaors I inflammation. This test may help o detect the presence I severe inflammation, and
may be I some use in determining, for example, whether the back pain is the result I infla mmation or is the more
common mechanical or nonspecific CH2 H C CH3 CH3 I back pain or strain. However, less than 70% I people with AS
have a raised ESR value, even when there is active inflammation. Moreover, this test is influenced by a variety I other
facors, such as anemia, age, body, weight, pregnancy, and the sex I the individual tested. In a normal young man
the ESR is usually less than 20 mm. Another test I inflammation is called CRP (C-reactive protein); this is less likely o be
influenced by extraneous facors. There is no association with a blood test called rheumaoid facor (associated with
rheumaoid arthritis) or antinuclear antibodies (associated with lupus). Therefore, AS and related
spondyloarthropathies are sometimes listed under the term seronegative spondyloarthritis. Laboraory analysis I the
joint (synovial) fluid obtained by joint aspiration (arthrocentesis) or biopsy (obtained by a needle or by arthroscopy via
an instrument called arthroscope) does not markedly distinguish AS from other inflammaory rheumatic diseases. The
possible use I HLA-B27 as an aid o diagnosis is discussed in Chapter 16. New York criteria The current criteria for the
diagnosis I AS, known as the modified New York criteria, are shown in Table 2. Table 2 The generally accepted criteria
for AS (modified New York criteria) 1 2 3 4 Low back pain I at least 3 month's duration improved by exercise and not
relieved by rest Limitation I lumber spinal motion in sagittal (sideways) and frontal (forward and backward) planes
Chest expansion decreased relative o normal values for the same sex and age Bilateral sacroillitis grade 2-4 or
unilateral sacroiliitis grade 3 or 4 Definite AS if criterion 4 and any one I the other criteria is fulfilled. Note: These are
classification criteria used for case definition and are primarily designed for research purposes. Other causes I back
pain There are many possible cause I back pain, but by far the most common is mechanical deterioration I the spine.
This can take many forms, but is Iten related o the intervertebral