BackgroundInflammatory back pain (IBP) is a key symptom of axial spondyloarthritis (AxSpA). Most items of the IBP criteria are subjective and liable to change depending on the patient’s expression. (1)ObjectivesAssessment of the sensitivity, specificity, and reliability of IBP parameters and sets in patients with AxSpA.MethodsThis case-control study was conducted on 2 groups: the first group included 103 patients with AxSpA, and the other group included 103 patients with chronic mechanical back pain. A standardized questionnaire, addressing all items included in Calin, Berlin, and ASAS criteria sets, was applied by 2 rheumatologists (one senior and one junior) to both groups. The sensitivity, specificity, and reliability of the 3 sets and individual parameters were assessed.ResultsMorning stiffness > 30 minutes was the most specific parameter (81%), while the insidious onset was the most sensitive (98%). Calin set was the most sensitive set (88.1%), but it had the least specificity (60%). Adding the item of Morning stiffness > 30 minutes to Calin criteria resulted in improving the specificity of Calin criteria to 81%. Reliability of all parameters and the 3 sets showed moderate agreement (kappa 0.422–0.588) except for Morning stiffness > 30 minutes which showed good agreement (kappa 0.736) and night pain which showed fair agreement (kappa 0.388) (Table 1).Table 1.Reliability of IBP parameters and criteria setsIBP parameterKappa AgreementAge of onset less than 40 years1.000Insidious onset0.581Morning stiffness0.588Morning stiffness more than 30 min0.736Improvement with exercise0.566No improvement with rest0.422Improvement with exercise and no improvement with rest0.508Night pain0.388Awakening in night due to pain0.553Buttock pain0.504Global Evaluation0.951CriteriaCalin0.556Berlin0.496ASAS0.455modified. Calin0.694ConclusionMost IBP parameters and criteria have moderate reliability and average sensitivity and specificity. There may be a need for an objective tool to differentiate between inflammatory and mechanical back pain.Reference[1]Poddubnyy D, Callhoff J, Spiller I, Listing J, Braun J, Sieper J, Rudwaleit, M (2018) Diagnostic accuracy of inflammatory back pain for axial spondyloarthritis in rheumatological care. RMD open, 4(2): e000825.http://dx.doi.org/10.1136/rmdopen-2018-000825Acknowledgements:NIL.Disclosure of InterestsMohammed A Mortada Speakers bureau: NOVARTIS.SANDOS.EVA, Grant/research support from: EVA, NOHA EHAB: None declared, Eman Elshahawy: None declared, Safaa Elnaggar: None declared.
Background: Back pain (BP) is a common musculoskeletal symptom that affects a large percentage of the population. Back pain can be classified according to the cause into mechanical and inflammatory. Inflammatory back pain (IBP) has some distinguishing characters that help in differentiation of it from mechanical back pain. Back pain in axial spondyloarthritis is usually of inflammatory type. There are a number of sets of criteria that have been devised to define IBP. These include the assessment of spondyloarthritis international society (ASAS) IBP experts' criteria, Berlin criteria, as well as Calin criteria. Objective: Assessment of overlap of pain character in patients with inflammatory back pain versus chronic mechanical back pain. Methods: Pain, Inflammatory Back Pain, and Chronic Mechanical Back Pain were all looked for in PubMed, Google scholar, and Science direct. References from relevant literature were also evaluated by the authors, but only the most recent or complete study from February 2006 to June 2022 was included. Due to the lack of sources for translation, documents in languages other than English have been ruled out. Papers that did not fall under the purview of major scientific investigations, such as unpublished manuscripts, oral presentations, conference abstracts, and dissertations, were omitted. Conclusion:There is a great overlap in character of back pain between patients with chronic mechanical back pain and those with axial spondyloarthritis.
BackgroundEvaluation of disease activity and functional impairment in Axial spondyloarthritis (AxSpA) are important in therapeutic plan. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and The Bath Ankylosing Spondylitis Functional Index (BASFI) scores are based largely on subjective measures, which liable to change depending on patient’s expression, culture, and awareness.ObjectivesAssessment of reliability of BASFAI, BASDAI, ASDAS-ESR, and ASDAS-CRP as a total score and individual questions in patients with AxSpA.MethodsThis cross-sectional study was conducted on 103 patients with AxSpA according to the ASAS classification criteria for AxSpA. Each patient completed BASFAI, BASDAI, ASDAS-ESR, and ASDAS-CRP during their routine visit for follow up with one rheumatologist. Then the same patients completed the three questionnaires again in the same day or on the second day with another rheumatologist.ResultsInternal consistency and reliability of ASDAS-ESR, ASDAS-CRP, BASDAI, and BASFAI scores was good (ICC was 0.841, 0.820, 0.767, and 0.852 respectively). Reliability of BASFAI score was better than that of ASDAS-ESR, ASDAS-CRP, BASDAI scores, and that of ASDAS-ESR, ASDAS-CRP was better than reliability of BASDAI score.Table 1.Interclass Correlation Coefficient of BASFAI in AxSpA patients reported by observer 1 and observer 2VariablesCronbach’s AlphaICCCI1) Putting on your socks or tights without help or aids (e.g sock aid) (F1).0.9310.8710.815-0.9112) Bending from the waist to pick up a pen from the floor without aid (F2).0.9030.8230.749-0.8773) Reaching up to a high shelf without help or aids (e.g helping hand) (F3).0.8370.7190.612-0.8014) Getting up from an armless chair without your hands or any other help (F4).0.7510.6010.462-0.7115) Getting up off the floor without help from lying on your back(F5).0.7790.6380.508-0.7406)Standing unsupported for 10 minutes without discomfort (F6).0.7070.5470.396-0.6697) Climbing 12-15steps without using a handrail or walking aid (F7).0.8630.7600.664-0.8318) Looking over your shoulder without turning your body (F8).0.8870.7980.715-0.8589)Doing physically demanding activities (e.g physiotherapy exercises, gardening or sports) (F9).0.8170.6900.573-0.77910) Doing a full day’s activities whether it be at home or at work (F10).0.7480.5980.458-0.709Total BASFAI Score0.9200.8520.789-0.898ICC (.21 to.4) was indicative of fair agreement, ICC (.41 to.6) was indicative of moderate agreement, ICC (.61 to.8) was indicative of substantial agreement, ICC (.81 to.99) was indicative of almost perfect agreement, and ICC (1) was indicative of perfect agreement.ConclusionSome questions of ASDAS, BASDAI, and BASFAI scores are more reliable than others, this depends on the question. The answers of the questions that assess sensation of pain, are liable to change. While the answers of other questions that assess stiffness or assess its duration are less liable to change. Questions that assess certain daily activity are more reliable than that assess the ability to do more than one activity.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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