Abstract
It is important to recognize inflammatory back pain (IBP) for an early diagnosis of ankylosing spondylitis (AS). Assessment of Spondyloarthritis International Society (ASAS) has recently published new criteria set for diagnosing IBP. In the present study, we evaluated the performance of the new ASAS IBP criteria and to compare the performance of IBP criteria sets in axial spondyloarthritis (axSpA) patients with and without radiographic sacroiliitis. The study sample included a total of 274 patients with a diagnosis of axSpA and 50 patients with a diagnosis of chronic (>3 months) mechanical back pain (MBP). A face-to-face interview by using a standardized questionnaire addressing all the components of IBP was performed. Data about HLA-B27 status and C-reactive protein levels were obtained from the patients’ charts. There were significantly more male patients (P < 0.001) in the AS group (68.6 %) than in the non-radiographic axSpA group (29.6 %) and also than in the MBP group (37.5 %). Among the criteria sets, the Calin criteria showed the best sensitivity (91.2 %), and the Berlin criteria showed the best specificity (82.4 %) in differentiation of IBP from MBP. If the morning stiffness item of the Calin criteria was defined as lasting >30 min (Calin 30), the specificity improved (72.9 %), but at a price of loss in sensitivity (82.4 %). In this study, new ASAS criteria for IBP performed almost as good as but not better than the existing criteria sets. Performances of the criteria sets were quite comparable in the differentiation of IBP from MBP in patients with and without radiographic sacroiliitis.
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Gerdan V, Akar S, Solmaz D, Pehlivan Y, Onat AM, Kisacik B, Sayarlioglu M, Erhan C, Tezcan ME, Ozturk MA, Onen F, Akkoc N (2012) Initial diagnosis of lumbar disc herniation is associated with a delay in diagnosis of ankylosing spondylitis. J Rheumatol 39(10):1996–1999. doi:10.3899/jrheum.120106
Calin A, Porta J, Fries JF, Schurman DJ (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237(24):2613–2614
Akar S, Birlik M, Aksu K, Senocak O, Akkoc N, Kabasakal Y, Onen F (2009) Clinical history for inflammatory back pain in ankylosing spondylitis: the sensitivity, specificity and consistency of clinical features. Rheumatol Int 29(3):349–351. doi:10.1007/s00296-008-0678-5
Rudwaleit M, Metter A, Listing J, Sieper J, Braun J (2006) Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 54(2):569–578. doi:10.1002/art.21619
Sieper J, van der Heijde D, Landewe R, Brandt J, Burgos-Vagas R, Collantes-Estevez E, Dijkmans B, Dougados M, Khan MA, Leirisalo-Repo M, van der Linden S, Maksymowych WP, Mielants H, Olivieri I, Rudwaleit M (2009) New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS). Ann Rheum Dis 68(6):784–788. doi:10.1136/ard.2008.101501
Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J, Braun J, Chou CT, Collantes-Estevez E, Dougados M, Huang F, Gu J, Khan MA, Kirazli Y, Maksymowych WP, Mielants H, Sorensen IJ, Ozgocmen S, Roussou E, Valle-Onate R, Weber U, Wei J, Sieper J (2009) The development of Assessment of SpondyloArthritis International Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis 68(6):777–783. doi:10.1136/ard.2009.108233
van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27(4):361–368
Rudwaleit M, Jurik AG, Hermann KG, Landewe R, van der Heijde D, Baraliakos X, Marzo-Ortega H, Ostergaard M, Braun J, Sieper J (2009) Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group. Ann Rheum Dis 68(10):1520–1527. doi:10.1136/ard.2009.110767
Garrett S, Jenkinson T, Kennedy LG, Whitelock H, Gaisford P, Calin A (1994) A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol 21(12):2286–2291
Calin A, Garrett S, Whitelock H, Kennedy LG, O’Hea J, Mallorie P, Jenkinson T (1994) A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. J Rheumatol 21(12):2281–2285
Keeling SO, Majumdar SR, Conner-Spady B, Battie MC, Carroll LJ, Maksymowych WP (2012) Preliminary validation of a self-reported screening questionnaire for inflammatory back pain. J Rheumatol 39(4):822–829. doi:10.3899/jrheum.110537
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Solmaz, D., Akar, S., Soysal, O. et al. Performance of different criteria sets for inflammatory back pain in patients with axial spondyloarthritis with and without radiographic sacroiliitis. Clin Rheumatol 33, 1475–1479 (2014). https://doi.org/10.1007/s10067-014-2622-2
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DOI: https://doi.org/10.1007/s10067-014-2622-2