Classification Criteria: Peripheral Spondyloarthropathy and Psoriatic Arthritis

  • William J. Taylor
  • Philip C. Robinson
Part of the following topical collections:
  1. Topical Collection on Psoriatic Arthritis


Recent proposals for re-classification of spondyloarthropathies according to the predominance of peripheral and axial manifestations and for non-radiographic ankylosing spondylitis to be re-named axial spondyloarthritis are reviewed. It is argued that such proposals are less likely to advance knowledge in the study of spondyloarthopathies and that accurate classification criteria for defined diseases, for example psoriatic arthritis, remain as necessary now as they ever did. The CASPAR criteria remain the best performing classification criteria for psoriatic arthritis.


Psoriatic arthritis Spondyloarthritis Classification criteria Peripheral spondyloarthropathy 



This work was supported by the facilities of the University of Otago and University of Queensland. Dr Taylor is a member of GRAPPA; Dr Robinson is an associate member of ASAS.

Conflict of Interest

Dr Taylor has consulted for Metabolex.

Dr Robinson declares that he has no conflict of interest.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    van der Linden S, Valkenberg HA, Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis: a proposal for modifications of the New York criteria. Arthritis Rheum. 1984;27(4):361–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009;68(6):777–83.PubMedCrossRefGoogle Scholar
  3. 3.
    •• Rudwaleit M, van der Heijde D, Landewe R, Akkoc N, Brandt J, Chou CT, et al. The Assessment of SpondyloArthritis International Society classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general. Ann Rheum Dis. 2011;70(1):25–31. This study proposes new classification criteria for SpA that have peripheral manifestations and potentially re-defines several diseases that fall under the SpA umbrella. Classification criteria that identify SpA in general are also defined by merging criteria for axial and peripheral SpA.PubMedCrossRefGoogle Scholar
  4. 4.
    Moll JMH, Haslock I, Macrae IF. Associations between ankylosing spondylitis, psoriatic arthritis, Reiter’s disease, the intestinal arthropathies and Behçet’s syndrome. Medicine (Baltimore). 1974;53:343–64.CrossRefGoogle Scholar
  5. 5.
    Wright V, Moll JMH. Seronegative Polyarthritis. Amsterdam: North Holland Publishing Co.; 1976.Google Scholar
  6. 6.
    Burns T, Marder A, Becks E, Sullivan L, Calin A. Undifferentiated spondylarthritis: a nosological missing link? Arthritis Rheum. 1982;25(Suppl):s142.Google Scholar
  7. 7.
    Dougados M, van der Linden S, Juhlin R, Huitfeldt B, Amor B, Calin A, et al. The European Spondyloarthropathy Study Group preliminary criteria for the classification of spondyloarthropathy. Arthritis Rheum. 1991;34(10):1218–27.PubMedCrossRefGoogle Scholar
  8. 8.
    Johnson SR, Goek ON, Singh-Grewal D, Vlad SC, Feldman BM, Felson DT, et al. Classification criteria in rheumatic diseases: a review of methodologic properties. Arthritis Rheum. 2007;57(7):1119–33.PubMedCrossRefGoogle Scholar
  9. 9.
    Collantes E, Veroz R, Escudero A, Munoz E, Munoz MC, Cisnal A, et al. Can some cases of ‘possible’ spondyloarthropathy be classified as ‘definite’ or undifferentiated’ spondyloarthropathy? Value of criteria for spondyloarthropathies. Joint Bone Spine. 2000;67:516–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Stafford L, Kane D, Murphy E, Duffy T, Lassere M, Youssef PP, et al. Psoriasis predicts a poor short-term outcome in patients with spondylarthropathy. Arthritis Care Res. 2001;45(6):485–93.CrossRefGoogle Scholar
  11. 11.
    Amor B, Dougados M, Mijiyawa M. Criteria of the classification of spondylarthropathies. Rev Rheum Mal Osteoartic. 1990;57(2):85–9.Google Scholar
  12. 12.
    Rudwaleit M, Landewe R, van der Heijde D, Listing J, Brandt J, Braun J, et al. The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part I): classification of paper patients by expert opinion including uncertainty appraisal. Ann Rheum Dis. 2009;68(6):770–6.PubMedCrossRefGoogle Scholar
  13. 13.
    • van Tubergen A, Weber U. Diagnosis and classification in spondyloarthritis: identifying a chameleon. Nature Rev Rheumatol. 2012;8(5):253–61. This is a useful review of the topic and highlights some important difficulties.CrossRefGoogle Scholar
  14. 14.
    Rudwaleit M. New approaches to diagnosis and classification of axial and peripheral spondyloarthritis. Curr Opin Rheumatol. 2010;22(4):375–80.PubMedCrossRefGoogle Scholar
  15. 15.
    Rudwaleit M, Khan MA, Sieper J. The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum. 2005;52(4):1000–8.PubMedCrossRefGoogle Scholar
  16. 16.
    • Bakland G, Alsing R, Singh K, Nossent JC. Assessment of spondyloarthritis international society criteria for axial spondyloarthritis in chronic back pain patients with high HLA B27 prevalence. Arthritis Care Res (Hoboken). 2012. Published online 25 July 2012. doi: 10.1002/acr.21804. Application of the axSpA criteria arm that uses HLA-B27 to identify patients leads to a high population prevalence of SpA. The prevalence of axSpA defined by HLA-B27 was 0.09% compared to a prevalence of 0.04% of radiographic axSpA.
  17. 17.
    •• Baeten D, Breban M, Lories R, Schett G, Sieper J. Spondyloarthritides: Related but distinct conditions or a single disease with a heterogeneous phenotype? Arthritis Rheum. 2013;65(1):12–20. Another useful review that discusses the difficult issue of exactly how different SpA diseases are related. PubMedCrossRefGoogle Scholar
  18. 18.
    Nash P, Mease PJ, Braun J, van der Heijde D. Seronegative spondyloarthropathies: to lump or split? Ann Rheum Dis. 2005;64 suppl 2:ii9–ii13.PubMedCrossRefGoogle Scholar
  19. 19.
    Taylor WJ, Gladman DD, Helliwell PS, Marchesoni A, Mease PJ, Mielants H. Classification criteria for Psoriatic Arthritis: new criteria from a large international study. Arthritis Rheum. 2006;54(8):2665–73.PubMedCrossRefGoogle Scholar
  20. 20.
    Helliwell PS. Relationship of psoriatic arthritis with the other spondyloarthropathies. Curr Opin Rheumatol. 2004;16(4):344–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W, et al. Evaluation of early diagnostic criteria for ankylosing spondylitis in a 10 year follow-up. Z Rheumatol. 1990;49(2):82–7.PubMedGoogle Scholar
  22. 22.
    Mau W, Zeidler H, Mau R, Majewski A, Freyschmidt J, Stangel W, et al. Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol. 1988;15(7):1109–14.PubMedGoogle Scholar
  23. 23.
    • Robinson PC, Wordsworth BP, Reveille JD, Brown MA. Axial Spondyloarthritis - A new disease entity, not necessarily early Ankylosing Spondylitis. Ann Rheum Dis. 2012; published online October 25, 2012. doi:  10.1136/annrheumdis-2012-202073. This paper reviews evidence that SpA with axial symptoms are far more heterogeneous than ankylosing spondylitis and suggests that it is premature to consider axSpA as the same disease as ankylosing spondylitis.
  24. 24.
    Sieper J, van der Heijde D, Dougados M, Mease PJ, Maksymowych WP, Brown MA, et al. Efficacy and safety of adalimumab in patients with non-radiographic axial spondyloarthritis: results of a randomised placebo-controlled trial (ABILITY-1). Ann Rheum Dis. 2012 published online July 7, 2012: doi: 10.1136/annrheumdis-2012-201766
  25. 25.
    Agency EM. CHMP post-authorisation summary of positive opinion for Humira 2012 [cited 2012 29 Nov 2012]; Available from:
  26. 26.
    Zeidler H, Amor B. The Assessment in Spondyloarthritis International Society (ASAS) classification criteria for peripheral spondyloarthritis and for spondyloarthritis in general: the spondyloarthritis concept in progress. Ann Rheum Dis. 2011;70(1):1–3.PubMedCrossRefGoogle Scholar
  27. 27.
    Battistone MJ, Manaster BJ, Reda DJ, Clegg DO. The prevalence of sacroilitis in psoriatic arthritis: new perspectives from a large, multicenter cohort. A Department of Veterans Affairs Cooperative Study. Skeletal Radiol. 1999;28(4):196–201.PubMedCrossRefGoogle Scholar
  28. 28.
    •• van den Berg R, van Gaalen F, Helm VD, van Mil A, Huizinga T, van der Heijde D. Performance of classification criteria for peripheral spondyloarthritis and psoriatic arthritis in the Leiden early arthritis cohort. Ann Rheum Dis. 2012;71(8):1366–9. This useful study of early arthritis was able to clearly show that the CASPAR criteria for classifying psoriatic arthritis was more accurate than the new ASAS pSpA criteria and that all SpA criteria (ASAS, Amor, ESSG) have less than desirable sensitivity for classifying SpA in early disease.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of MedicineUniversity of Otago WellingtonWellingtonNew Zealand
  2. 2.University of Queensland Diamantina Institute, Princess Alexandra HospitalWoolloogabbaAustralia

Personalised recommendations