Abstract
BackgroundIn the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA). The objectives of this study were to determine the frequency of current IBP, as a hallmark sign of possible axial SpA, in patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) and other SpA and to compare self-reported health between the groups with current IBP.MethodsFive-thousand seven hundred seventy one patients identified in the regional healthcare register of the most southern county of Sweden, diagnosed at least once by a physician (based on ICD-codes) with any type of SpA in 2003–2007, were sent a postal survey in 2009. Patients with current IBP were identified, based on self-reported back pain ≥3 months in the preceding year and fulfilling the Berlin criteria for IBP. The frequencies of IBP in AS, PsA and other SpA (including the remaining subgroups of SpA) were determined, and the groups were compared with regard to patient reported outcome measures (PROMs).ResultsThe frequency and proportion of patients with current IBP in AS, PsA and other SpA were 319 (43 %), 409 (31 %) and 282 (39 %) respectively, within the responders to the survey (N = 2785). The proportion was statistically higher in AS, compared to PsA (p < 0.001), but not for AS compared to other SpA (p = 0.112). PsA and other SpA, with current IBP, had similar (BASFI, EQ-5D, patients global assessment, fatigue, spinal pain) or worse (BASDAI) PROMs, compared to AS with current IBP. PsA with current IBP received pharmacological, anti-rheumatic, treatment more frequently than AS with current IBP, while AS and other SpA received treatment to a similar degree.ConclusionThe proportion of patients with current IBP was substantial in all three groups and health reports in the non-AS groups were similar or worse compared to the AS group supporting the severity of IBP in these non-AS SpA groups. These findings may indicate a room for improvement concerning detection of axial disease within different subtypes of non-AS SpA, and possibly also for treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-0960-8) contains supplementary material, which is available to authorized users.
Highlights
In the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA)
In a clinical setting SpA-disease is often categorized through its most prominent feature, e.g. psoriatic arthritis (PsA), SpA associated with inflammatory bowel disease (IBD), reactive arthritis (ReA) or axial SpA
Axial SpA having resulted in radiographically detectible sacroilitis is clinically diagnosed as ankylosing spondylitis (AS) [3], while axial SpA without radiographic sacroilitis may be classified as non-radiographic axial-SpA, according to the “Assessment of SpondyloArthritis” (ASAS) criteria for axial SpA[1].AS is known to be more common in men and non-radiographic axial SpA in women, and the progression rate from non-radiographic axial SpA to AS is considered to be around 10–12 % over 2 years [1]
Summary
In the broader spectrum of back pain, inflammatory back pain (IBP) is a symptom that may indicate axial spondyloarthritis (SpA). Neither the modified New York criteria for AS [4] nor the current ASAS criteria for axial SpA[5] includes past or present IBP as a compulsory feature. Both the sensitivity and the specificity of IBP for axial SpA, classified according to the ASAS-criteria in the setting of established axial SpA or chronic back pain, is 70–80 % [6, 7], illustrating the fact that not all patients with axial SpA have IBP and that axial disease activity may vary over time [8]
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