Ankylosing spondylitis
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Suspicion
Laboratory tests
- FBC
- CRP
- Serum urate
- Rheumatoid factor (if peripheral form)if neededPredominantly peripheral form (mono-, oligo- or polyarthritis): the HAS considers immunological tests (rheumatoid factor, anti-CCP, antinuclear antibodies) useful to look for another inflammatory rheumatic disease [2]. Not useful in a purely axial form.
- Anti-CCP antibodies (if peripheral form)if neededPredominantly peripheral form (mono-, oligo- or polyarthritis): the HAS considers immunological tests (rheumatoid factor, anti-CCP, antinuclear antibodies) useful to look for another inflammatory rheumatic disease [2]. Not useful in a purely axial form.
- Antinuclear antibodies (if peripheral form)if neededPredominantly peripheral form (mono-, oligo- or polyarthritis): the HAS considers immunological tests (rheumatoid factor, anti-CCP, antinuclear antibodies) useful to look for another inflammatory rheumatic disease [2]. Not useful in a purely axial form.
- HIV serology (if peripheral form)if neededPredominantly peripheral form (arthritis): the HAS algorithm includes HIV, HBV and HCV serology in the differential diagnosis of arthritis [2]. Not useful in a purely axial form.
- Hepatitis B serology (if peripheral form)if neededPredominantly peripheral form (arthritis): the HAS algorithm includes HIV, HBV and HCV serology in the differential diagnosis of arthritis [2]. Not useful in a purely axial form.
- Hepatitis C serology (if peripheral form)if neededPredominantly peripheral form (arthritis): the HAS algorithm includes HIV, HBV and HCV serology in the differential diagnosis of arthritis [2]. Not useful in a purely axial form.
- HLA-B27if neededSuggestive clinical or radiological signs without diagnostic certainty: a positive result strengthens the body of evidence, a negative result rules out nothing [2]. HLA class I phenotype listed in the NABM (procedure 1180, B 380) in autoimmune diseases, in an affected person when the diagnosis can be supported by the genetic background [3].
- Not a laboratory test: PA X-ray of the pelvis and of painful sites.
Also consider
- Ocular signs of uveitis? Urgent ophthalmologist opinion; aetiological work-up in the page "Uveitis (looking for a cause)".
Do not order
Follow-up
Laboratory tests
- CRP
- Not a laboratory test: clinical assessment of disease activity (BASDAI or ASDAS-CRP) by the rheumatologist.
Also consider
- Anti-TNF being considered? For the tests before anti-TNF and its monitoring, see the page "Biothérapie ou inhibiteur de JAK".
Sources (8)
- Spondyloarthrites Des douleurs dorsales exacerbées par le repos
- Spondylarthrite ankylosante (HAS, 2008)
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : acte 1180 (phénotype HLA classe I, B 380) et texte « Groupages tissulaires » rattaché à l'acte 1827 ; absence d'acte actif pour la vitesse de sédimentation.
- Spondylarthrite inflammatoire
- National Institute for Health and Care Excellence (NICE). Spondyloarthritis in over 16s: diagnosis and management. NICE guideline NG65, 28 février 2017 (dernière mise à jour indiquée : 2 juin 2017 ; deux recommandations de traitement revues en 2025).
- Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Care Res (Hoboken) 2019;71(10):1285-1299.
- Wendling D, Hecquet S, Fogel O, et al. 2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis. Joint Bone Spine 2022;89(3):105344.
- Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023;82(1):19-34.