Ab0999 reliability of Inflammatory Back Pain Criteria as a Tool for Differentiation Between Inflammatory and Mechanical Back Pain Among Egyptian Patients

Abstract

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.