In 1984, a joint effort led to the definition of specific classification criteria for ankylosing spondylitis,

called the “Modified New York Criteria”.[4] One of the central New York criteria was the existence
of radiographically visible changes in the sacroiliac joints and/or spine, which have formed due to
bone fusion, erosion and/or formation caused by the disease. [5] Even though these criteria helped to
improve uniformly define ankylosing spondylitis, such radiologic changes often only manifested
several years after the first disease symptoms appeared. [5] In order to be able to study also patients
with early and less typical forms, new criteria were needed that could identify the disease already at
an early stage. In 2009 the Modified New York criteria were extended by a broad set of new
classification criteria that aimed to classify patients based on the presence of typical
spondyloarthritis disease features.[1] These included inflammatory back pain, family history for axial
spondyloarthritis, response to treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), past
history of or current inflammation in the joints (arthritis), tendon-bone attachment of the heel
(enthesitis), or eyes (uveitis), bowel (inflammatory bowel disease), skin (psoriasis) or signs of
elevated inflammation (C-reactive protein and erythrocyte sedimentation rate. [1] [6] Important parts of
the ASAS axSpA criteria is the biomarker HLA-B27 and magnetic resonance imaging (MRI).[1][6] The
criteria can only be applied in people that have chronic back pain (at least 3 months duration) started
before the age of 45 years and only in those patients that already have a diagnosis of axial SpA.
Since the disease ankylosing spondylitis was still defined by the Modified New York criteria of 1984,
there was the need to find a new disease term that would also include the less severe forms or early
onset of ankylosing spondylitis. This expression was found in the umbrella term axial
spondyloarthritis. The 2009 classification criteria are called the ASAS (Assessment of
SpondyloArthritis international Society) axial spondayloarthritis criteria. [