Clinical assessment in the spondyloarthropathies, including psoriatic arthritis

The different diseases of the spondyloarthropathy concept share common clinical characteristics. Nevertheless, the assessment of disease activity/severity in an individual patient remains difficult. Specific research is starting to focus on the development of valid, feasible and reliable outcome tools that are sensitive to change.

No global assessment instrument is available that evaluates the whole disease spectrum in spondyloarthropathy. The majority of tools are designed to measure a specific aspect of the disease. The Assessments in Ankylosing Spondylitis international working group response criteria have been validated in multiple trials and more stringent criteria are now emerging to describe the major responses seen with biologic agents. The assessment of peripheral arthritis is still essentially borrowed from other rheumatologic conditions with some modification as to the number of joints that need to be evaluated. With regard to the assessment of specific features such as enthesitis and dactylitis, new methods are proposed that await validation.

New assessment tools or modifications to existing tools have been described, but most still need validation and general acceptance. The debate is ongoing as to whether one should evaluate the different aspects of the spondyloarthropathies separately or an 'all-in' assessment tool should be constructed.