Gastrointestinal lesions associated with spondyloarthropathies

Table 1 European Spondyloarthropathy Study Group (ESSG) classification criteria for spondyloarthritis

Inflammatory spinal pain, or synovitis (asymmetrical, predominantly in lower limbs), and any one of the following:

Positive family history

Psoriasis

Inflammatory bowel disease

Alternate buttock pain

Enthesopathy

Table 2 Amor classification criteria for spondyloarthropathy

Clinical symptoms or past history of

Lumbar or dorsal pain at night, or lumbar or dorsal morning stiffness = 1

Asymmetrical oligoarthritis = 2

Buttock pain (buttock pain = 1, alternating buttock pain = 2)

Sausage-like finger or toe = 2

Heel pain = 2

Iritis = 2

Non-gonococcal urethritis or cervicitis accompanying, or within 1 mo before, the onset of arthritis = 1

Acute diarrhoea accompanying, or within 1 mo before, the onset of arthritis = 1

Presence of history of psoriasis and/or balanitis and/or of inflammatory bowel disease (ulcerative colitis, Crohn's disease) = 2

Radiological findings

Sacroiliitis (grade > 2 if bilateral, grade > 3 if unilateral) = 3

Genetic background

Presence of HLA-B27 and/or family history of ankylosing spondylitis, reactive arthritis, uveitis, psoriasis or chronic inflammatory bowel disease = 2

Response to therapy

Definite improvement of musculoskeletal complaints with NSAIDs in less than 48 h or relapse of the pain in less than 48 h if NSAIDs discontinued = 2

A patient is considered as having a spondyloarthropathy if the sum of the scores is 6 or more

Table 3 Histologic types of gut inflammation in patients with SpA

Acute	Chronic
Architecture preserved	Architecture disturbed
PMN infiltration	Irregular, blunted and fused villi
Granulocytes, lymphocytes, plasma cells in lamina propria	Distortion crypts
	Basal lymphoid follicles
	Sarcoid-like granulomas