Inflammatory back pain in ankylosing spondylitis: A reassessment of the clinical history for application as classification and diagnostic criteria

Wiley - Tập 54 Số 2 - Trang 569-578 - 2006
Martín Rudwaleit1, Anke Metter, Joachim Listing, Joachim Sieper, Jürgen Braun
1Charité, Campus Benjamin Franklin, Berlin, Germany. [email protected]

Tóm tắt

AbstractObjectiveBack pain associated with ankylosing spondylitis (AS) is referred to as inflammatory back pain (IBP). The value of the clinical history in differentiating IBP from mechanical low back pain (MLBP) has been investigated in only a few studies. In this exploratory study, we sought to evaluate the individual features of IBP and to compose and compare various combinations of features for use as classification and diagnostic criteria.MethodsWe assessed the clinical history of 213 patients (101 with AS and 112 with MLBP) younger than 50 years who had chronic back pain. Single clinical parameters and combinations of parameters were compared between the AS and MLBP patient groups.ResultsMorning stiffness of >30 minutes' duration, age at onset of back pain, no improvement in back pain with rest, awakening because of back pain during the second half of the night only, alternating buttock pain, and time period of the onset of back pain were identified as independent contributors to IBP. Importantly, none of the single parameters sufficiently differentiated AS from MLBP. In contrast, several sets of combined parameters proved to be well balanced between sensitivity and specificity. Among these, a new candidate set of criteria for IBP, which consisted of morning stiffness of >30 minutes' duration, improvement in back pain with exercise but not with rest, awakening because of back pain during the second half of the night only, and alternating buttock pain, yielded a sensitivity of 70.3% and a specificity of 81.2% if at least 2 of these 4 parameters were fulfilled (positive likelihood ratio 3.7). If at least 3 of the 4 parameters were fulfilled, the positive likelihood ratio increased to 12.4.ConclusionA new set of criteria for IBP performed better than previous criteria in AS patients with established disease. A prospective study is needed to validate the diagnostic properties of the new candidate criteria set in patients with early disease.

Từ khóa


Tài liệu tham khảo

10.1136/ard.61.suppl_3.iii8

10.1002/1529-0131(199801)41:1<58::AID-ART8>3.0.CO;2-G

10.1093/rheumatology/38.9.831

10.1002/1529-0131(200006)43:6<1356::AID-ANR20>3.0.CO;2-Y

10.7326/0003-4819-136-12-200206180-00011

10.1001/jama.1977.03270510035017

10.1097/00007632-198003000-00016

10.1016/S0002-9343(88)80018-4

10.1001/jama.1992.03490060092030

10.1097/00007632-199502000-00010

10.1093/rheumatology/34.11.1074

10.1136/ard.2004.028753

10.1002/art.1780280107

10.1136/ard.2003.011247

Hart FD, 1949, Ankylosing spondylitis, Q J Med, 18, 217

10.1002/art.1780270401

10.1007/BF02032287

10.3109/03009748809098810

10.1093/rheumatology/keh205

10.1016/S0889-857X(05)70281-7

10.1056/NEJM200102013440508

10.1007/s00296-002-0237-4

10.1002/art.1780270301

10.1136/ard.55.4.268

Schober P, 1937, Lendenwirbelsäule und Kreuzschmerzen, Munch Med Wochenschr, 84, 336

10.1093/rheumatology/30.1.29

10.1001/jama.1994.03510330081039

10.3109/03009748309098552

10.1007/BF02032066

Jaeschke R, 1994, Users' guides to the medical literature. III. How to use an article about a diagnostic test. A. Are the results of the study valid?, JAMA, 271, 389, 10.1001/jama.1994.03510290071040

10.1136/bmj.324.7336.539

Thông tin
Thông tin xuất bản

Wiley

Tập 54 Số 2

569-578

Thông tin tác giả