Abstract
This study aims to investigate features of different diseases with low back pain misdiagnosed as spondyloarthropathy so as to improve the accuracy of diagnosis for spondyloarthropathy. The clinical and laboratory data of 24 cases misdiagnosed as spondyloarthropathy in recent 3 years were comparatively and retrospectively analyzed. The diagnostic accuracy of the European Spondyloarthropathy Study Group (ESSG) criteria, Amor criteria, and the combination of them in these misdiagnosed cases was also analyzed. The final diagnoses of these 24 cases were listed below: four malignant tumors (retroperitoneal adipose sarcoma, advanced gastric carcinoma, ovarian papillary epithelioma, acute lymphocytic leukemia), six benign tumors (two parathyroid adenoma with hyperparathyroidism, one intraspinal lipoma, intraspinal ependymomas, sacral tubulocyst, and intraspinal schwannoglioma, respectively). The other 14 cases included fibromyalgia syndrome (3), osteitis condensans (3), diffuse idiopathic skeletal hyperostosis (2), lumbar intervertebral disk protrusion (1), congenital scoliosis (1), Wilson’s disease (1), ochronosis (1), Fanconi syndrome (1) and hypophosphatemic rachiopathy (1). Among patients with tumor, all except three patients had persistent low back pain without morning stiffness, which aggravated at night and could not be relieved by rest or exercise. The symptoms could not be relieved by administration of multiple nonsteroidal anti-inflammatory drugs. Eleven patients had inflammatory low back pain defined by Calin. Of the total misdiagnosed cases, 54.17–83.33% could be prevented by application of ESSG criteria or Amor criteria, or a combination of them. From the data, we could see that the clinical features of different diseases with low back pain were different from each other and from those of spondyloarthropathy. The various criteria for spondyloarthropathy may be more effective in combination, along with other clinical information like these clinical features.
Similar content being viewed by others
References
Dougados M, van der Linden S, Juhlin R et al (1991) The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum 34:1218–1227
Amor B, Dougados M, Mijiawa M et al (1990) Criteria of classification of SpA. Rev Rheum 57:85–89
Calin A (1986) Seronegative spondyloarthritides. Med Clin North Am 70:323–336
Deyo RA, Weinstein JN (2001) Low back pain. New Engl J Med 344:363–370
Naschitz JE, Yeshurun D, Rosner I (1995) Rheumatic manifestations of occult cancer. Cancer 75:2954–2958
Deyo RA (1986) Early diagnostic evaluation of low back pain. J Gen Intern Med 1:328–338
Atlas SJ, Chang Y, Kammann E et al (2000) Long-term disability and return to work among patients who have a herniated lumbar disc: the effect of disability compensation. J Bone Joint Surg Am 82:4–15
Andersson GBJ (1999) Epidemiologic features of chronic low-back pain. Lancet 354:581–585
Brewer GJ (2000) Recognition, diagnosis, and management of Wilson's disease. Proc Soc Exp Biol Med 223:39–46
Collantes E, Veroz R, Escudero A et al (2000) Can some cases of ‘possible’ SpA be classified as ‘definite’ or ‘undifferentiated’ SpA? Value of criteria for SpA. Spanish SpA Study Group. Joint Bone Spine 67:516–520
Amor B (2000) Usefulness of criteria for SpA. Joint Bone Spine 67:502–503
Rudwaleit M, van der Heijde D, Khan MA et al (2004) How to diagnose axial spondylarthritis early. Ann Rheum Dis 63:535–543
Zeng QY (2000) Early diagnosis of ankylosing spondylitis. Chin J Rheumatol 4:69–71
Sieper J, Rudwaleit M (2005) Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 64:659–663
Rudwaleit M, Khan MA, Sieper J (2005) The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 52:1000–1008
Disclosures
None
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Deng, X.L., Liu, X.Y. & Xu, N. Comparative study on low back pain misdiagnosed as spondyloarthropathy. Clin Rheumatol 28, 893–898 (2009). https://doi.org/10.1007/s10067-009-1198-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-009-1198-8