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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The history of ankylosing spondylitis &#40;AS&#41; has evolved since the first descriptions &#40;2000 years BC&#41;&#44; passing through the Middle Ages and&#44; especially&#44; the second half of the 20th century&#44; with the discovery of HLA B27 &#40;1973&#41;&#46; In the fifties of the last century&#44; there were 2 opposing schools of thought&#58; the North American &#40;&#8220;lumpers&#8221;&#41; and the European &#40;&#8220;splitters&#8221;&#41;&#44; which considered AS to be a variant of rheumatoid arthritis &#40;RA&#41;&#44; or as a different entity&#44; respectively&#46; Then evidence arose that was favorable to their separation&#44; grouping AS and other similar diseases as &#8220;seronegative arthritides&#8221; or &#8220;spondyloarthritides&#8221; &#40;Moss and Wright&#44; 1976&#41;&#46; At the present time&#44; we prefer calling them &#8220;spondyloarthritis&#8221; &#40;SpA&#41;&#44; a name that indicates its inflammatory nature&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With respect to the diagnosis&#44; classification tools have been appearing&#44; from the criteria of Boland and Present &#40;1945&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> then those of Rome &#40;1961&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> New York &#40;1966&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and their modification &#40;1984&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Their major drawback is the limited sensitivity in the initial stages&#44; as they require the radiographic diagnosis of sacroiliitis&#46; To make up for these limitations&#44; in the nineties we had the publication of the criteria of Amor<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and those of the European Spondyloarthropathy Study Group &#40;ESSG&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> which included radiographic sacroiliitis but not as a necessary requirement&#44; extending the diagnostic spectrum to the group of undifferentiated spondyloarthritis&#46; Recently&#44; the criteria of the Assessment of Spondyloarthritis International Society &#40;ASAS&#41; have enabled us to improve its early diagnosis&#44; classifying SpA into 2 groups&#46; One group is comprised of predominantly axial SpA &#40;2009&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> which includes classical AS &#40;radiographic sacroiliitis&#44; meeting the modified New York criteria&#41; and pre-radiographic or non-radiographic axial SpA &#40;with the support of sacroiliac magnetic resonance imaging&#41;&#46; The other consists of predominantly peripheral SpA &#40;2011&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> including psoriatic and reactive arthritis and arthritis associated with inflammatory bowel disease and undifferentiated SpA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless&#44; there are patients who cannot be classified using the new ASAS criteria&#44; although their clinical data suggest SpA&#44; as occurs in the following clinical setting&#58; a 40-year-old man with a 1-year history of inflammatory low back pain&#44; HLA B27-negative&#44; normal levels of acute-phase reactants&#44; good response to nonsteroidal anti-inflammatory drugs &#40;NSAID&#41; and 2 earlier episodes of uveitis&#46; First-degree family history of psoriasis&#46; Radiographs showing bilateral sacroiliitis &#40;left&#44; grade 2&#44; and right&#44; grade 1&#41;&#44; with no MRI evidence of edema&#47;osteitis in sacroiliac joints&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Within the group of non-radiographic &#8220;or pre-radiographic&#8221; axial spondyloarthritides &#40;nr axSpA&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> includes those patients with a normal radiography or initial sacroiliitis&#44; that does not meet the modified New York criteria &#40;no AS&#41;&#44; have MRI-evidence of edema in sacroiliac joints&#59; however&#44; what would occur if we found patients without edema in MRI and without radiographic damage in the sacroiliac joints&#63; How would they be classified&#63;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Introducing certain small changes into the nomenclature&#44; we could speak of non-radiographic &#40;or pre-radiographic&#41; axial SpA in those cases in which MRI is positive for sacroiliac involvement&#44; according to ASAS criteria&#44; with normal radiographies or minimal changes in these joints&#44; but do not meet the modified New York criteria&#46; However&#44; on the other hand&#44; radiographic axSpA that is not AS&#44; patients in whom there are initial radiographic changes in the sacroiliac joints &#40;without meeting the modified New York criteria&#41; and whose MRI is negative &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In any case&#44; studies in which the sensitivity and specificity of these modifications is evaluated are necessary&#46; They could make it easier to achieve a better classification of those patients with incipient radiographic changes during the initial stages who have a negative MRI study&#46;</p></span>"
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Axial SpA&nbsp;\t\t\t\t\t\t\n
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Letter to the Editor
Axial Spondyloarthritis: Can All Be Classified?
Espondiloartritis axiales: ¿se pueden clasificar todas?
Manuel José Moreno Ramosa,
Corresponding author
mjmoreno1@yahoo.es

Corresponding author.
, Maria José Moreno Martinezb, Luis Francisco Linares Ferrandoa
a Servicio de Reumatología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
b Unidad de Reumatología, Hospital Rafael Méndez, Lorca, Murcia, Spain
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    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Axial Spondyloarthritis&#58; Can All Be Classified&#63;"
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        "titulo" => "Espondiloartritis axiales&#58; &#191;se pueden clasificar todas&#63;"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The history of ankylosing spondylitis &#40;AS&#41; has evolved since the first descriptions &#40;2000 years BC&#41;&#44; passing through the Middle Ages and&#44; especially&#44; the second half of the 20th century&#44; with the discovery of HLA B27 &#40;1973&#41;&#46; In the fifties of the last century&#44; there were 2 opposing schools of thought&#58; the North American &#40;&#8220;lumpers&#8221;&#41; and the European &#40;&#8220;splitters&#8221;&#41;&#44; which considered AS to be a variant of rheumatoid arthritis &#40;RA&#41;&#44; or as a different entity&#44; respectively&#46; Then evidence arose that was favorable to their separation&#44; grouping AS and other similar diseases as &#8220;seronegative arthritides&#8221; or &#8220;spondyloarthritides&#8221; &#40;Moss and Wright&#44; 1976&#41;&#46; At the present time&#44; we prefer calling them &#8220;spondyloarthritis&#8221; &#40;SpA&#41;&#44; a name that indicates its inflammatory nature&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With respect to the diagnosis&#44; classification tools have been appearing&#44; from the criteria of Boland and Present &#40;1945&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> then those of Rome &#40;1961&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> New York &#40;1966&#41;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> and their modification &#40;1984&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Their major drawback is the limited sensitivity in the initial stages&#44; as they require the radiographic diagnosis of sacroiliitis&#46; To make up for these limitations&#44; in the nineties we had the publication of the criteria of Amor<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and those of the European Spondyloarthropathy Study Group &#40;ESSG&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> which included radiographic sacroiliitis but not as a necessary requirement&#44; extending the diagnostic spectrum to the group of undifferentiated spondyloarthritis&#46; Recently&#44; the criteria of the Assessment of Spondyloarthritis International Society &#40;ASAS&#41; have enabled us to improve its early diagnosis&#44; classifying SpA into 2 groups&#46; One group is comprised of predominantly axial SpA &#40;2009&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> which includes classical AS &#40;radiographic sacroiliitis&#44; meeting the modified New York criteria&#41; and pre-radiographic or non-radiographic axial SpA &#40;with the support of sacroiliac magnetic resonance imaging&#41;&#46; The other consists of predominantly peripheral SpA &#40;2011&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> including psoriatic and reactive arthritis and arthritis associated with inflammatory bowel disease and undifferentiated SpA&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Nevertheless&#44; there are patients who cannot be classified using the new ASAS criteria&#44; although their clinical data suggest SpA&#44; as occurs in the following clinical setting&#58; a 40-year-old man with a 1-year history of inflammatory low back pain&#44; HLA B27-negative&#44; normal levels of acute-phase reactants&#44; good response to nonsteroidal anti-inflammatory drugs &#40;NSAID&#41; and 2 earlier episodes of uveitis&#46; First-degree family history of psoriasis&#46; Radiographs showing bilateral sacroiliitis &#40;left&#44; grade 2&#44; and right&#44; grade 1&#41;&#44; with no MRI evidence of edema&#47;osteitis in sacroiliac joints&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Within the group of non-radiographic &#8220;or pre-radiographic&#8221; axial spondyloarthritides &#40;nr axSpA&#41;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> includes those patients with a normal radiography or initial sacroiliitis&#44; that does not meet the modified New York criteria &#40;no AS&#41;&#44; have MRI-evidence of edema in sacroiliac joints&#59; however&#44; what would occur if we found patients without edema in MRI and without radiographic damage in the sacroiliac joints&#63; How would they be classified&#63;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Introducing certain small changes into the nomenclature&#44; we could speak of non-radiographic &#40;or pre-radiographic&#41; axial SpA in those cases in which MRI is positive for sacroiliac involvement&#44; according to ASAS criteria&#44; with normal radiographies or minimal changes in these joints&#44; but do not meet the modified New York criteria&#46; However&#44; on the other hand&#44; radiographic axSpA that is not AS&#44; patients in whom there are initial radiographic changes in the sacroiliac joints &#40;without meeting the modified New York criteria&#41; and whose MRI is negative &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">In any case&#44; studies in which the sensitivity and specificity of these modifications is evaluated are necessary&#46; They could make it easier to achieve a better classification of those patients with incipient radiographic changes during the initial stages who have a negative MRI study&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Moreno Ramos MJ&#44; Moreno Martinez MJ&#44; Linares Ferrando LF&#46; Espondiloartritis axiales&#58; &#191;se pueden clasificar todas&#63; Reumatol Clin&#46; 2017&#59;13&#58;59&#8211;60&#46;</p>"
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          "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AS&#44; ankylosing spondylitis&#59; CIBD&#44; chronic inflammatory bowel disease&#59; MRI&#44; magnetic resonance imaging&#59; nr axSpA&#44; non-radiographic &#40;or pre-radiographic&#41; axial spondyloarthritis&#59; radiographic axSpA no AS&#44; radiographic axial spondyloarthritis no ankylosing spondylitis&#59; SpA&#44; spondyloarthritis&#59;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Axial SpA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">AS &#40;&#43; radiographies&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Reactive arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">nr axSpA &#40;MRI&#43; radiography&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psoriatic arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Radiographic axSpA not AS &#40;radiography&#43; not AS&#44; MRI&#8722;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Arthritis associated with CIBD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Undifferentiated SpA&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735743
Original language: English
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Idiomas
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