Alternating Buttock Pain Research Articles

OA21 Ankylosing Spondylitis management with Secukinumab but related Inflammatory bowel disease phenomenon

Introduction/BackgroundAnkylosing spondylitis is a HLA B27 associated inflammatory spondyloarthropathy. It can be a debilitating disease affecting mobility and quality of life, therefore, effective symptom and disease control is crucial and consists of pharmacological, including biologics, and non-pharmacological modalities. Until recently, pharmacological treatment options for spinal inflammatory disease control was limited to mainly NSAIDs. Development of biological drugs such as TNF inhibitors and selective Interleukin-17 inhibitors have revolutionized the management especially for patients refractory to conventional treatment. However, use of these novel biologics can come at a cost of side effects including risk of infection and exacerbation of underlying inflammatory conditions.Description/MethodThis 60-year-old Afro-Caribbean female was referred to Rheumatology department with 1-year history of non-radiating lower back pain, alternating buttock pain and morning stiffness. On spinal and sacral MRI, she was found to have multiple thoracic and lumbar spine Romanus lesions and active sacroiliitis and had bilateral grade 2-3 sacroiliitis on plain x-rays of the sacroiliac joints. She also had a raised ESR. There was no peripheral joint involvement, psoriasis, inflammatory eye disease or previous history of inflammatory bowel disease. Her HLA-B27 was negative. Subsequently, she was diagnosed with AS. Previously, she had tried NSAIDs via GP including Diclofenac and Naproxen. She was started on Etoricoxib.Other issues included spinal canal stenosis at L4/L5 due to disc degeneration, facet joint and ligamentum flavum hypertrophy.For non-pharmacological management she was under the care of physiotherapy team who advised for regular physiotherapy, acupuncture and hydrotherapy.On follow up, she did not derive benefit from the Etoricoxib (BASDAI 8.5 and VAS 75), consequently underwent pre-biologic work up. After these were confirmed as normal she was started on Secukinumab 150mg monthly injections (after weekly loading) as per the patient’s preferred biologic choice.After initiating Secukinumab, her AS improved significantly (reductions in BASDAI to 2.5 and VAS 30). However, after six months, she developed gastrointestinal symptoms with mainly bloating, intermittent diarrhoea and epigastric abdominal pain. She then developed gradual unintentional weight loss.Under gastroenterologist care, she had extensive diagnostic workup including upper GI endoscopy and colonoscopy (with biopsies), CT-TAP, MRI small bowel and faecal elastase, all of which were normal. However, her faecal calprotectin was high at 130mg/kg (normal range 0-51mg/kg).Secukinumab was continued given her spinal disease improvement, however, after 18 months of therapy and ongoing gastrointestinal symptoms, Secukinumab was stopped in May-2021. Within weeks of stopping her GI symptoms completely resolved.Discussion/ResultsUse of Secukinumab has been licensed for rheumatological diseases such as psoriatic arthritis, AS and plaque psoriasis. It works by antagonizing interleukin 17, which is a pro-inflammatory cytokine. We started Secukinumab in this patient as per patient choice.Considering she developed gastrointestinal symptoms it was important to rule out IBD as Secukinumab has been associated with exacerbating underlying IBD or even inducing new cases. For this purpose, part of our workup included faecal calprotectin, colonoscopy and MRI to rule out IBD.We recommend for patient who are being treated with Secukinumab that if they develop gastrointestinal symptoms it is important to consider iatrogenic IBD. It is recommended in such cases to discontinue Secukinumab and consider alternative biologics with a different mode of action.It is still not clear what risk factors may help to predict which patients treated with Secukinumab for AS (or other seronegative disorders) could develop iatrogenic IBD. It is also unclear why the epiphenomenon of IBD can be exacerbated by IL17 inhibition when it is clear that such cytokine targeting in AS, psoriasis and psoriatic arthritis is evidently beneficial. Is there a role in pre-biologic screening and monitoring during treatment using faecal calprotectin?Key learning points/ConclusionThough Secukinumab is an effective biologic in the management of symptoms and disease control in Ankylosing spondylitis it can be associated with either flare or development of Inflammatory Bowel Disease phenomenon.

Validation of screening criteria for spondyloarthritis in patients with inflammatory bowel disease in routine clinical practice.

Spondyloarthritis (SpA) is one of the most common extraintestinal manifestations of inflammatory bowel disease (IBD). Diagnostic delay must be avoided. We assessed the validity of SpA screening criteria (any of the following characteristics: chronic low back pain with onset before 45 years of age; inflammatory lower back pain or alternating buttock pain; arthritis; heel enthesitis; dacylitis; HLA-B27 positivity; sacroiliitis on imaging). This was a multicenter cross-sectional observational study in IBD patients aged ≥18 years. After evaluating the SpA screening criteria, the gastroenterologists referred the participants to the rheumatologists, who determined whether the patient fulfilled the screening criteria and carried out the necessary tests for SpA diagnosis. 35 (11.7%) out of 300 patients were diagnosed with SpA. The combination with the best balance between sensitivity and specificity (91.4% and 72.1%, respectively, when applied by the rheumatologists; 80% and 78.9%, when applied by the gastroenterologists) for SpA screening, was fulfillment of any of the following: chronic low back pain with onset before age 45 years, inflammatory low back pain or alternating buttock pain, arthritis, or dactylitis. This is one of the first studies to validate SpA screening criteria in IBD patients in routine clinical practice.

P22 Between the devil and the deep blue sea – a diagnostic dilemma

P22 Between the devil and the deep blue sea – a diagnostic dilemma

SPINAL INVOLVEMENT IN PSORIATIC ARTHRITIS, CLINICAL AND RADIOLOGICAL STUDY

Psoriatic arthritis is chronic inflammatory condition affecting multiple tissues including skin and joints. Axial psoriatic arthritis (axPsA) forms part of the SpA spectrum, may occur in the form of spondylitis with or without sacroiliitis. Spondylitis presents clinically with spinal stiffness and pain, while sacroiliitis causes alternating buttock pain. Although different classification criteria have been used for axPsA, a clear distinction is still not available. Spondylitis occurs in 40% of patients with PsA and may result in fusion of the vertebrae. These manifestations may be present on radiological examination without symptoms or signs. Some patients had silent axial disease, thus it was suggested that in order to identify axPsA, recognition of which has prognostic value, rheumatologists should consider conducting axial imaging for all patients with PsA regardless the presence of back pain. Aim of the work: To study spinal involvement in patients with psoriatic arthritis clinically and radiographically.Patients and MethodsPatients:Fifty patients diagnosed with PsA according to the classification criteria for psoriatic arthritis (CASPAR) were enrolled. Patients were classified into three groups based on the absence or presence of spinal involvement clinically and/or radiographically: Group (Ι): patients with peripheral PsA (pPsA) only.Group (ΙI): PsA patients with radiographic axial involvement (AxPsA-R) Group (ΙII): PsA patients with clinical and radiographic axial involvement (AxPsA-CR). Patients with orthopedic diseases or other rheumatic disorders affecting the spine and psychiatric and neurological disorders were excluded.

Clinical, laboratory, and radiological characteristics of patients with late-onset spondylarthritis

IntroductionSpondylarthritis (SpA) is a chronic inflammatory disease that rarely began after 50 years of age. Aim of the work: To investigate the clinical, laboratory, and radiological characteristics of late-onset SpA (LOSpA) and compare them to early-onset (EOSpA). Patients and methods: A single-center cross-sectional study included 117 SpA patients and those with their initial symptoms starting after the age of 50 years were considered late-onset. Results: There were 102 patients (87.2%) with EOSpA and 15 (12.8%) with LOSpA. The mean age at onset for the EOSpA and LOSpA groups was 28.6 ± 9.1 and 54.5 ± 2.9 respectively. Female sex and presence of comorbidities were more associated with older age at onset (p = 0.03 and p = 0.008, respectively). Delay in diagnosis was shorter in the LOSpA group (p = 0.05), and they had less alternating buttock pain and hip involvement at onset of the disease (p = 0.005 and p < 0.001, respectively). Patients with EOSpA had more axial forms (p = 0.03). Uveitis, inflammatory bowel diseases (IBD), and human leucocyte antigen B27 (HLA-B27) positivity were significantly more common in the LOSpA group (p = 0.04; p = 0.05 and p = 0.04, respectively). There was no significant difference between the two groups in the laboratory investigations, anthropometric measures, and disease indices. Radiological findings were also comparable. Multiple logistic regression analysis revealed that only axial forms and HLA-B27 positivity were independently associated with the age of the disease onset. Conclusion: The late onset of the disease is more frequent in females with HLA-B27. The LOSpA patients had a shorter delay in diagnosis, more comorbidities, uveitis, and IBD.

Sacroiliac joint involvement in children with inflammatory bowel diseases.

Objective:Sacroiliitis (SI), an inflammatory arthropathy, may accompany pediatric inflammatory bowel diseases (IBDs), present with non- specific back pain, hence might be unnoticed. The aims of this study were to assess the frequency of the SI in children with IBD and determine the characteristics of the association of SI with the clinical hallmarks of the IBD.Methods:In this prospective, cross sectional study, twenty-seven children with IBD, 7–18 years of age were evaluated. Patients with low back pain or stiffness, alternating buttock pain, or hip pain were examined for the presence of SI. The radiologic manifestations on X-ray suggesting sacroilitis were confirmed with Magnetic resonance imaging (MRI).Results:Twenty-seven children (16 girls, female/male=1.45), with mean age of 12.55±3.6 years, of which 52% had ulcerative colitis (UC), 41% had Crohn’s disease (CD), and two had indeterminate colitis (IC). The median time from IBD diagnosis was 6.0 (18.0) months for patients with SI and 12.0 (13.5) months for patients without SI. Low back pain or stiffness was observed in 13 patients (48%). SI was present in eight (30%) of the children with IBD. The patients with CD were more prone to SI (45% of CD vs. 21% of UC patients). All patients with SI were negative for HLA-B27 genotyping. The disease activity and gender were not associated with increased risk for SI. MRI was remarkable for bone marrow edema in all of the patient, followed by erosions in six of them (75%), synovial enhancement observed in five (63%), and erosion associated enthesitis of the pelvic region was observed in two (25%) of the patients.Conclusion:SI may remain obscured in children with IBD. Children with CD are more prone to SI than those with UC. Pediatric rheumatology-pediatric gastroenterology collaboration might augment screening in at-risk patients.

Screening of Inflammatory Bowel Disease and Spondyloarthritis for Referring Patients Between Rheumatology and Gastroenterology

ObjectiveTo define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service. MethodSystematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardisation and ease of application. Afterwards, members of the expert panel assessed each item in a two-round Delphi survey. Items that met agreement in the first or second round were included in the final version of the criteria. ResultsPositive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhoea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anaemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD. ConclusionScreening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be useful for early detection of both diseases.

Screening of Inflammatory Bowel Disease and Spondyloarthritis for Referring Patients Between Rheumatology and Gastroenterology.

To define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service. Systematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardization and ease of application. Afterwards, members of the expert panel assessed each item in a two-roundDelphisurvey. Items that met agreement in the first or second round were included in the final version of the criteria. Positive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD. Screening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be useful for early detection of both diseases.

Association Between Inflammatory Back Pain Characteristics and Magnetic Resonance Imaging Findings in the Spine and Sacroiliac Joints

To investigate the association between magnetic resonance imaging (MRI) findings at the sacroiliac (SI) joints and vertebral endplates and pain characteristics assumed to be indicative of axial inflammation. Patients ages 18-40 years with persistent low back pain referred to an outpatient spine clinic participated, including an unknown proportion of axial spondyloarthritis patients. Data included MRI of the spine and SI joints and self-reported responses to questions covering the Calin, Berlin, Assessment of Spondyloarthritis International Society, and Bailly inflammatory back pain (IBP) definitions. In the 1,020 included patients, 53% were women, and the median age was 33 years. Positive associations were found between the SI joint MRI findings and pain characteristics, odds ratios ranging from 1.4 to 2.7. SI joint bone marrow edema (BME) was associated with morning stiffness >60 minutes, and SI joint erosions with the Calin, Berlin, and Bailly IBP definitions, alternating buttock pain, and good response to nonsteroidal antiinflammatory drugs. SI joint fatty marrow deposition (FMD) was associated with insidious onset, and SI joint sclerosis with pain at night. In addition, the spinal MRI changes were associated with IBP, odds ratios ranging from 1.4 to 2.0; vertebral endplate BME was associated with morning stiffness, and vertebral endplate FMD with the Calin and Bailly IBP definitions, improvement with exercise, morning stiffness >30 minutes, and pain worst in the morning. The identified associations between inflammatory MRI findings and pain characteristics indicate that axial inflammation to some degree induces a specific pain pattern. Thus, the results add to knowledge of axial inflammatory processes. However, all identified associations were weak, which compromises the use of IBP as a marker of axial inflammation.

Criterios de cribado de enfermedad inflamatoria intestinal y espondiloartritis para derivación de pacientes entre Reumatología y Gastroenterología

ObjectiveTo define clinical screening criteria for spondyloarthritis (SpA) in patients with inflammatory bowel disease (IBD) and vice versa, which can be used as a reference for referring them to the rheumatology or gastroenterology service. MethodSystematic literature review and a two-round Delphi method. The scientific committee and the expert panel were comprised of 2 rheumatologists and 2 gastroenterologists, and 7 rheumatologists and 7 gastroenterologists, respectively. The scientific committee defined the initial version of the criteria, taking into account sensitivity, specificity, standardization and ease of application. Afterwards, members of the expert panel assessed each item in a two-round Delphi survey. Items that met agreement in the first or second round were included in the final version of the criteria. ResultsPositive screening for SpA if at least one of the following is present: onset of chronic low back pain before 45 years of age; inflammatory low back pain or alternating buttock pain; HLA-B27 positivity; sacroiliitis on imaging; arthritis; heel enthesitis; dactylitis. Positive screening for IBD in the presence of one of the major criteria or at least two minor criteria. Major: rectal bleeding; chronic diarrhea with organic characteristics; perianal disease. Minor: chronic abdominal pain; iron deficiency anemia or iron deficiency; extraintestinal manifestations; fever or low grade fever, of unknown origin and duration >1week; unexplained weight loss; family history of IBD. ConclusionScreening criteria for IBD in patients with SpA, and vice versa, have been developed. These criteria will be useful for early detection of both diseases.

Sponyloarthritis features forecasting the presence of HLA-B27 or sacroiliitis on magnetic resonance imaging in patients with suspected axial spondyloarthritis: results from a cross-sectional study in the ESPeranza Cohort.

IntroductionChronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial spondyloarthritis (axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints (MRI-SI) in patients with suspected axSpA.MethodsData from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility measures (LR+, LR−) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back pain (IBP), their separate items and for other SpA features.ResultsPretest probabilityies of a positive result was 41 % for MRI-SI and 40 % for HLA-B27. For a positive MRI-SI result the most useful IBP characteristic was alternating buttock pain (LR + =2.6). Among the IBP-criteria, fulfillment of the ‘ASAS criteria’ (LR + =2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the Calin/ASAS-IBP criteria (LR + =6.0 and 5.5, respectively) or the addition of awakening at second half of night to the Calin-IBP criteria (LR + =5.5) increased the pre-test probability of MRI-sacroiliitis from 41 % to 79–80 %. Dactylitis (LR + =4.1) and inflammatory bowel disease (IBD) (LR + =6.4) increased this probability to 73 % and 81 %, respectively. To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS-IBP definition and uveitis were the most useful, but only marginally predictive (LR + = 1.3, 1,6 and 2.6, respectively).ConclusionsIf patients with suspected axial SpA have either 1) IBP according to Calin/ASAS definition plus alternating buttock pain, or 2) IBP according to Calin definition plus awakening at night, or 3) dactylitis or 4) IBD, the probability of finding a positive MRI-SI increases significantly.

Prevalence of chronic axial pain, inflammatory back pain, and spondyloarthritis in diagnosed psoriasis.

To provide prevalence estimates for inflammatory back pain (IBP) and spondyloarthritis (SpA) in those subjects with psoriasis using 2009-2010 National Health and Nutrition Examination Survey (NHANES) data. In the NHANES 2009-2010 sample set, 6,684 persons ages 20-69 years were screened for participation, and 5,103 answered questions regarding onset of back pain, location of pain, and functional limitations. Data set assembly and statistical analysis were performed using SASTM and SUDAAN software. SEs were estimated by Taylor series linearization. The equality of the prevalence estimates for selected variables was tested (univariately) at an alpha level of 0.05 using 2-sided Student's t-test with appropriate degrees of freedom. A total of 148 persons had self-reported medically diagnosed psoriasis. The psoriasis group versus the nonpsoriasis group had a significantly higher prevalence of axial pain using the 3-month duration criterion (31.1% versus 18.9%; P = 0.04) and alternating buttock pain (7.2% versus 2.4%; P = 0.03) and more frequently met IBP criteria from Berlin criteria 7b and 8a (P = 0.04 and 0.02, respectively). The prevalence of SpA was significantly higher in the psoriasis group versus the nonpsoriasis group when using Amor or European Spondyloarthritis Study Group criteria (14.3% versus 1.5%; P < 0.001). Sudden onset of axial pain was significantly higher in the psoriasis group (23.3% versus 13.0%; P = 0.01). There is a higher prevalence of lower axial pain, IBP, SpA, and alternating buttock pain associated with a prior diagnosis of psoriasis. These data may influence the way psoriasis patients are approached in primary care and specialty clinics.

Evaluation of performance of BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) in a Brazilian cohort of 1492 patients with spondyloarthritis: data from the Brazilian Registry of Spondyloarthritides (RBE)

ObjectiveTo analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. MethodsA common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applied. The total values of BASDAI were compared to the presence of the different variables. ResultsThe mean score of BASDAI was 4.20±2.38. The mean scores of BASDAI were higher in patients with the combined (axial+peripheral+entheseal) (4.54±2.38) clinical presentation, compared to the pure axial (3.78±2.27) or pure peripheral (4.00±2.38) clinical presentations (P<0.001). BASDAI also presented higher scores associated with the female gender (P<0.001) and patients who did not practice exercises (P<0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (P<0.049), alternating buttock pain (P<0.001), cervical pain (P<0.001) and hip involvement (P<0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (P=0.004) and upper limbs (P=0.025). The presence of enthesitis was also associated to higher scores of BASDAI (P=0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (P<0.001). ConclusionIn this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate “disease activity” in patients with axial as well as peripheral disease.

Avaliação do desempenho do BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) numa coorte brasileira de 1.492 pacientes com espondiloartrites: dados do Registro Brasileiro de Espondiloartrites (RBE)

To analyze the results of the application of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) in a large series of Brazilian patients with the diagnosis of SpA and establish its correlations with specific variables into the group. A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyoarthropathies Study Group (ESSG), attended at 29 referral centers of Rheumatology in Brazil. Clinical and demographic variables, and disease indices (BASDAI, Basfi, Basri, Mases, ASQol) were applicated. The total values of BASDAI were compared to the presence of the different variables. The mean score of BASDAI was 4.20 ± 2.38. The mean scores of BASDAI were higher in patients with the combined (axial + peripheral + entheseal) (4.54 ± 2.38) clinical presentation, compared to the pure axial (3.78 ± 2.27) or pure peripheral (4.00 ± 2.38) clinical presentations (p<0.001). BASDAI also presented higher scores associated with the female gender (p<0.001) and patients who did not practice exercises (p < 0.001). Regarding the axial component, higher values of BASDAI were significantly associated with inflammatory low back pain (p<0.049), alternating buttock pain (p<0.001), cervical pain (p<0.001) and hip involvement (p<0.001). There was also statistical association between BASDAI scores and the peripheral involvement, related to the lower (p=0.004) and upper limbs (p=0.025). The presence of enthesitis was also associated to higher scores of BASDAI (p=0.040). Positive HLA-B27 and the presence of cutaneous psoriasis, inflammatory bowel disease, uveitis and urethritis were not correlated with the mean scores of BASDAI. Lower scores of BASDAI were associated with the use of biologic agents (p<0.001). In this heterogeneous Brazilian series of SpA patients, BASDAI was able to demonstrate "disease activity" in patients with axial as well as peripheral disease.

Assessment of fatigue in a large series of 1492 Brazilian patients with Spondyloarthritis

Background. The aim of the present study was to analyze the score of fatigue in a large cohort of Brazilian patients with SpA, comparing different disease patterns and its association with demographic and disease-specific variables.Methods. A common protocol of investigation was prospectively applied to 1492 Brazilian patients classified as SpA according to the European Spondyloarthropathies Study Group (ESSG) criteria, attended at 29 reference centers. Clinical and demographic variables were recorded. Fatigue was evaluated using the first item of the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) questionnaire.Results. The mean BASDAI fatigue score was 4.20 ± 2.99. There was no significant difference in the fatigue score between the different SpA. Fatigue was higher in female patients (p < 0.001), with mixed (axial + peripheral) involvement (p < 0.001) and in those who did not practice exercises (p < 0.001). Higher scores of fatigue were significantly associated with inflammatory low back pain (p = 0.013), alternating buttock pain (p = 0.001), cervical pain (p = 0.001), and hip involvement (p = 0.005). Fatigue presented a moderate positive statistical correlation with Bath Ankylosing Spondylitis Functional Index (BASFI) (0.469; p < 0.001) and Ankylosing Spondylitis Quality of Life (0.462; p < 0.001).Conclusion. In this large series of Brazilian SpA patients, higher fatigue scores were associated with female gender, sedentary, worse functionality, and quality of life.

FRI0150 Chronic Back Pain (CBP) Characteristics Associated with the Presence of Sacroiliitis on Magnetic Resonance Imaging (MRI) in Patients with Suspected Axial Spondyloarthritis (AXSPA): Results from the Esperanza Cohort

BackgroundCBP is nowadays the starting point for the ASAS classification criteria for axSpA. Later, two possible entry criteria based on complementary examinations (imaging and HLA-B27) are considered. CBP is a...

AB0733 Which Chronic Back Pain (CBP) Characteristics Are Associated with A Positive HLA-B27 in Patients with Suspected Axial Spondyloarthritis (AXSPA)? Results from the Esperanza Cohort

BackgroundCBP is nowadays the starting point for the ASAS classification criteria for axSpA. Later, two possible entry criteria based on complementary examinations (HLA-B27 and imaging) are considered. However, CBP is...

THU0075 Assessment of the Degree by Which Fibromyalgia Patients Fulfill Each One of the Items Included in ALL 3 of the Existing Criteria which are Used to Define Inflammatory Back Pain

BackgroundAiming to assess whether Inflammatory back pain (IBP) criteria are met by patients with Fibromyalgia (FM) and which items from those used in IBP criteria offer best discriminatory ability between...

FRI0122 Evaluation of the Two-Step Referral Strategy for Axial Spondyloarthritis in the Spondyloarthritis Caught Early Cohort

BackgroundCurrently, in primary care no satisfactory referral model exists for referral to the rheumatologist of patients with chronic back pain (CBP) with possible axial spondyloarthritis (axSpA). Recently, a non-invasive, inexpensive...

THU0507 Is there a Knowledge Gap in Diagnosing Inflammatory Back Pain in Primary Care? - Regional Survey Among GPs in Leicestershire, UK

BackgroundAnkylosing sponylitis (AS) is an under-recognised inflammatory condition affecting 200 000 young men and women in the UK. It mostly affects young men before the age of 40 years. Current...