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)

Abstract

Objective: Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA), and relevant for classification and diagnosis. In the present report, a new approach for the development of IBP classification criteria is discussed. Methods: Rheumatologists (n = 13) who are experts in SpA took part in a 2-day international workshop to investigate 20 patients with back pain and possible SpA. Each expert documented the presence/absence of clinical parameters typical for IBP, and judged whether IBP was considered present or absent based on the received information. This expert judgement was used as the dependent variable in a logistic regression analysis in order to identify those individual IBP parameters that contributed best to a diagnosis of IBP. The new set of IBP criteria was validated in a separate cohort of patients (n = 648). Results: Five parameters best explained IBP according to the experts. These were: (1) improvement with exercise (odds ratio (OR) 23

Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients

“…As such, a number of criteria have been proposed to clinically differentiate inflammatory from mechanical back pain. The Inflammatory Back Pain (IBP) Experts' Criteria are robust, easy to apply, and have been validated in the international ASAS study on new classification criteria for AxSpA [41]. Therefore, these criteria, where at least four of five of the following parameters are present: (1) age at onset no greater than 40 years; (2) insidious onset; (3) improvement with exercise; (4) no improvement with rest; and (5) pain at night (with improvement upon getting up), are recommended for defining IBP in the ASAS-endorsed recommendations for early referral [21].…”

Inflammatory pain pattern and pain with lumbar extension associated with Modic 1 changes on MRI: a prospective case–control study of 120 patients

“…In the first part, patients completed a questionnaire about demographics (gender, age, sedentary work, sick leaves and their durations), and pain characteristics (duration since the first LBP episode, duration since pain heightening, presence of a triggering factor, associated sciatica, morning stiffness, waking at night because of LBP, maximal diurnal intensity pain period) as well as a standardized disability questionnaire validated in French [Dallas Pain Questionnaire (DPQ)] [10]. Inflammatory criteria were defined after review from recent literature on inflammatory back pain [11,12], and from inflammatory criteria of ankylosing spondylitis [13][14][15][16][17]. An inflammatory pain pattern was defined by the presence of at least one of three characteristics: maximal pain on morning, waking at night because of pain, and morning stiffness for longer than 60 min.…”

Classification of rheumatologic opinion on early inflammatory arthritis: Harmonization of a heterogeneous standard

“…Precise estimates of both expected agreement and effect sizes for the associations investigated were obtained with the 18 rheumatologists and 30 cases used. The number of rheumatologist evaluators and cases used also compares favorably with other studies that have investigated interrater agreement (1,43,44).…”

“…Rheumatologic assessments of case summaries are imperfectly correlated with the clinical management of real patients (5). Validation of these findings in the clinical setting would be ideal but poses additional logistical challenges relative to existing examples of related efforts with prevalent conditions (44). Future research on early IA should include the ERRR as a standardized adjunct to rheumatologic opinion to circumvent interstudy variability of the definition of the study population.…”