BackgroundThe hip joint is a site of involvement in a number of rheumatic conditions. Patients are often complaining of hip pain. The “Hip” as a complaint or a joint involved in disease is being used, as a metric in a number of indices or questionnaires, to evaluate IBP (1) or Spondyloarthropathies (such as BASDAI question 2) (2). However, what patients are describing as “hip” pain is not always referred to the actual hip joint.ObjectivesTo assess which structure(s) patients indicate when they are referring to hip pain.MethodsA diagram has been developed which has been used as a proforma to design on the site of “hip pain” from patients (new and/or follow up) when seen in clinic. After detailed history and examination, an accurate description of the site referred to as “hip” was recorded. Radiological imaging was utilised, for those patients with either multiple sites or clinically unclear causes of “hip” pain, to confirm or exclude the clinical diagnosis for the pain. The study classified as an audit and took place at a single centre between August 2014 and September 2015.ResultsA total of 54 patients (M:F 10:44) have been assessed [mean age of 57.6 years (sd ±14.1)]. Total sites identified and evaluated were 72 as 14 patients of 54 (25.9%) indicated more than 1 site when describing their hip pain [10 patients:2 sites (18.5%), 4 patients (7.4%) 3 sites]. A total of 8 structures have been described by patients as the site of their hip pain. These (in addition to the hip joint) were: trochanterum, iliac crests (including anterior superior, posterior superior and anterior inferior) lumbar spine, sacroiliiac joint. Radiological evaluation performed on 40/54 patients (74%). From those, 23 patients had X-rays (57.5%), 13 patients had ultrasound (32.5%), 4 patients (10%) had MRI.Following clinical and radiologic evaluation the structures identified and confirmed as the source of the hip pain were: Trochanterum (n=19; 26.3%), followed by hip joint (n=15; 20.8%), Iliac crest (n=13; 18%), Lumbo-sacral spine (n=6; 8.3%), posterior superior iliac crest (n=6; 8.3%), anterior superior iliac crest (n=5; 6.9%), Sacro-iliac joint (n=5; 6.9%), and anterior inferior iliac crest (n=3; 4.1%).ConclusionsA total of 80% of patients presented with “Hip pain” were referring to a different structure than the hip joint in our study. The greater trochanter was the most commonly reported anatomical structure of pain from patients when they were referring to hip pain. The hip joint itself was 2nd in the frequency of reported hip pain, seen in only 1 in 5 patients coming to clinic complaining of hip pain. We therefore suggest the “hip pain” item, used in questionnaires that do not include clinical evaluation, has to be interpreted with caution.ReferencesKeeling SO, Mjundar SR, Conner-Spady B. et al. Preliminary validation of a self reported screening questionnaire for IBP. J. Rheumatol 2012;39:822–29Garrett S, Jenkinson T, Kennedy LG, et al. A new approach to defining disease status in ankylosing spondylitis: The Bath Ankylosing Spondylitis Dis...

ObjectivesTo assess the differences in the occurrence of co-morbidities from cardiovascular, respiratory, renal/urological and Central nervous systems (CNS) between patients with spondyloarthritis (SpA) not having headache as presenting symptom and those having headache assuming that those describing headache represent secondary (s) fibromyalgia (FM). (previous submitted abstract provides justification on headache as presenting symptom associated with secondary sFM).MethodsData obtained through a questionnaire from 776 patients seen in clinic with SpA was analysed with reference to headache as symptom at presentation. From the total 776 patients 13 patients did not record an answer to the question and were hence excluded. The remaining 763 patients were divided in 2 groups: Those having headache at presentation (n=117) considered having sFM, and those not having headache at presentation (n=656).The data of patients with sFM were compared with the data of patients who did not report headache as a presentation symptom therefore not having FM with regards to age, disease duration, delay in diagnosis, disease activity (BASDAI) functional ability (BASFI), ESR, CRP and associated co morbidities from cardiovascular, respiratory, renal/urinary, and CNS systems. Central nervous system was evaluated by symptoms of dizziness and numbness.Independent sample T test was used to explore differences between the 2 groups and confidence intervals obtained.ResultsTable shows demographics and disease characteristics as well as differences between SpA patients presenting with headache (indicating secondary FM), and those not presenting with headache. A greater proportion of patients with SpA and headache (sFM) report cardiovascular and CNS co-morbidities. There was no significant difference noted in the respiratory or renal/ urological co-morbidities amongst the 2 sub-groups.Headache at presentation (n=117)No headache at presentation (n=656)Statistical significance (p)CI Age (mean ± SD)47.7 (13.16)48.3 (14.3)0.1-5.757 to 0.912Gender (M:F) ratio28:89 1:3.1219:419 1:1.90.3-0.025 to 0.077Disease duration11.4 (12.1)10.9 (10.8)0.4-1.905 to 4.470Delay in diagnosis6.43 (8.9)6.3 (8.1)0.7-3.151 to 2.151ESR15.5 (14.8)18.2 (18)0.07-11.064 to 0.582CRP10.4 (36)8.2 (9.8)0.4-6.106 to 12.536BASDAI score7.31 (3.7)6.06 (2.08)0.000 (<0.005)0.783 to 2.624BASFI score5.6 (2.7)5.04 (2.7)0.09-0.143 to 1.626Main problemFatigue77/116 (66.4%)340/608 (55.9%)0.0180.029 to 0.299Pain with pressure71/117 (61.2%)257/807 (42.4%)0.0000.122 to 0.378Co-morbiditiesHeart16/100 (16%)59/479 (12.3%)0.0020.44 to 0.196Lungs11/99 (11.1%)52/475 (10.9%)0.1-.014 to 0.135Dizziness50 (104) 48.1%147/408 (30.1%)0.0000.220 to 0.453Numbness58 (105) 55.2%199/505 (39.4%)0.0000.188 to 0.441Kidneys/urology23 (102) 22.5%100/479 (20.9%)0.1-0.31 to 0.188ConclusionsA significantly higher proportion of patients described cardiovascular and CNS co-morbidities in the sFM group of SpA. No significant difference was noted in the 2 sub-groups with regards to the respiratory or renal systems.Disclosur...

ObjectivesTo evaluate the symptom of headache as being able to clinically distinguish associated secondary fibromyalgia in patients with spondyloarthropathies (SpA). To compare the incidence of MSK complaints (related to SpA) in patients with headache to those that did not. To assess headache during the SpA disease course.MethodsRegistry data from 776 patients seen in clinic with SpA were analysed with reference to headache as symptom at presentation. The data of those patients presented with headache were compared with data of those patients who did not report headache with regards to demographics and disease characteristics. In addition, other MSK complaints, fatigue and pain during disease course were also analysed.ResultsFrom a total of 776 patients (m: f=265:508) age 48.3 ( SD +14.1), 13 were excluded as no answer was recorded. 117/ 763 patients (15.08%) representing 28 males and 89 females (23.9% vs 76.1% ratio 1:3.1) reported headache at disease onset.During the disease course, 13 patients out of the initial 117 did not record an answer to the question and were excluded. From remaining 104 patients, 95 patients (91.3%) continued to describe headache as a symptom.From those not reporting headache as initial symptom, (n=659) 148 did not record an answer and were excluded. From the remaining 511 patients, 194 (37.9%) reported headache during the disease course.On the data obtained from these 2 sub-groups, comparison took place using paired sample t-test.Table shows demographics and disease characteristics as well as differences between the 2 SpA sub-groups. Those presenting with headache describe worse disease, more fatigue and a greater percentage describe pain at pressure points and MSK system.Headache at presentationNo headache at presentationStatistical significanceCI (n=117)(n=656)(p) Age (mean ± SD)47.7 (13.16)48.3 (14.3)0.1-5.757 to 0.912Gender (M:F) ratio28:89 (1:3.1)219:419 (1:1.9)0.3-0.025 to 0.077Disease duration (y) (mean ± SD)11.4 (12.1)10.9 (10.8)0.4-1.905 to 4.470Delay in diagnosis (y) (mean ± SD)6.43 (8.9)6.3 (8.1)0.7-3.151 to 2.151ESR (mean ± SD) mmHg15.5 (14.8)18.2 (18)0.07-11.064 to 0.582CRP (mean ± SD) mg/dL10.4 (36)8.2 (9.8)0.4-6.106 to 12.536BASDAI score (mean ± SD)7.31 (3.7)6.06 (2.08)<0.0050.783 to 2.624BASFI score (mean ± SD)5.6 (2.7)5.04 (2.7)0.09-0.143 to 1.626Buttock pain (%)31.612.80.0010.083 to 0.293Back pain (%)82.958.8<0.0050.125 to 0.337Neck pain (%)72.624.4<0.0050.340 to 0.583Knee pain (%)63.230.6<0.0050.284 to 0.520Shoulder (%)70.923<0.0050.312 to 0.559Foot (%)57.222<0.0050.279 to 0.524Hip (%)55.519.9<0.0050.217 to 0.467Eye (%)234.3<0.0050.102 to 0.274Fatigue77/116 (66.4%)340/608 (55.9%)0.0180.029 to 0.299Pain with pressure71/117 (61.2%)257/807 (42.4%)0.0000.122 to 0.378Headache as co-morbidity95 (109) 87.2%195/509 (38.3%)0.0000.808 to 0.935ConclusionsHeadache can clinically represent secondary FM among SpA patients. A proportion of patients (representing 15%) report headache at presentation. The majority of those patients (>90%) continue to describe headache during the dis...