This misconception
may result from slower progression of the typical spinal changes in
women. Many investigators have tried to set and refine guidelines for
the diagnosis of AS. However, current diagnostic criteria mean
that a definite diagnosis of AS cannot be made unless the person shows
unequivocal radiological evidence of X ray change in the pelvis. This
criteria does not acknowledge juvenile patients or those in their late
teens or early twenties with disease activity that has not progressed
to the point where the changes in their pelvis is unequivocally detected
by the X ray. Thus, the diagnosis and treatment of AS in the early
stages may often be related more to the persons clinical presentation
and to the doctors personal experience and intuition than precise diagnostic
criteria.
Early diagnosis
of AS is highly desirable because it enables the treatment to start
before permanent damage has occurred. However, a global consensus
needs to be reached on criteria for diagnosis and classification for
AS that reflects the broad range of symptoms and spinal changes.
At present
a wide assortment of methods for assessing AS have been suggested but
no particular method has been accepted universally and no guidelines
for the use of assessment measures have been established.
However,
a workshop (ie the Ankylosing spondylitis Workshop Berlin, Germany Jan
2002) on the new treatment strategies was a timely event that profiles
a solid foundation to enable dramatic improvement in the management
of people with AS in the near future. For the first time there
is a real possibility of controlling and modifying the course of AS.
This summary
is an edited version of Prof. Khan's article ' Ankylosing spondylitis
: introductory comments on its diagnosis and treatment' Ann Rheum
Dis 2002 SIII: iii3-iii5
