Rudwaleit Martin, Metter Anke, Listing Joachim, Sieper Joachim, Braun Jürgen
Charité, Campus Benjamin Franklin, Berlin, Germany.
Arthritis Rheum. 2006 Feb;54(2):569-78. doi: 10.1002/art.21619.
Back pain associated with ankylosing spondylitis (AS) is referred to as inflammatory back pain (IBP). The value of the clinical history in differentiating IBP from mechanical low back pain (MLBP) has been investigated in only a few studies. In this exploratory study, we sought to evaluate the individual features of IBP and to compose and compare various combinations of features for use as classification and diagnostic criteria.
We assessed the clinical history of 213 patients (101 with AS and 112 with MLBP) younger than 50 years who had chronic back pain. Single clinical parameters and combinations of parameters were compared between the AS and MLBP patient groups.
Morning stiffness of >30 minutes' duration, age at onset of back pain, no improvement in back pain with rest, awakening because of back pain during the second half of the night only, alternating buttock pain, and time period of the onset of back pain were identified as independent contributors to IBP. Importantly, none of the single parameters sufficiently differentiated AS from MLBP. In contrast, several sets of combined parameters proved to be well balanced between sensitivity and specificity. Among these, a new candidate set of criteria for IBP, which consisted of morning stiffness of >30 minutes' duration, improvement in back pain with exercise but not with rest, awakening because of back pain during the second half of the night only, and alternating buttock pain, yielded a sensitivity of 70.3% and a specificity of 81.2% if at least 2 of these 4 parameters were fulfilled (positive likelihood ratio 3.7). If at least 3 of the 4 parameters were fulfilled, the positive likelihood ratio increased to 12.4.
A new set of criteria for IBP performed better than previous criteria in AS patients with established disease. A prospective study is needed to validate the diagnostic properties of the new candidate criteria set in patients with early disease.
与强直性脊柱炎（AS）相关的背痛被称为炎性背痛（IBP）。仅有少数研究探讨了临床病史在区分IBP与机械性下背痛（MLBP）方面的价值。在这项探索性研究中，我们试图评估IBP的个体特征，并构建和比较各种特征组合，以用作分类和诊断标准。
我们评估了213例年龄小于50岁且患有慢性背痛的患者（101例AS患者和112例MLBP患者）的临床病史。比较了AS患者组和MLBP患者组的单个临床参数及参数组合。
持续时间超过30分钟的晨僵、背痛发病年龄、休息后背痛无改善、仅在夜间后半程因背痛醒来、交替性臀部疼痛以及背痛发病时间段被确定为IBP的独立影响因素。重要的是，没有一个单一参数能够充分区分AS和MLBP。相比之下，几组组合参数在敏感性和特异性之间表现出良好的平衡。其中，一组新的IBP候选标准，包括持续时间超过30分钟的晨僵、运动后背痛改善但休息后无改善、仅在夜间后半程因背痛醒来以及交替性臀部疼痛，如果满足这4个参数中的至少2个，则敏感性为70.3%，特异性为81.2%（阳性似然比3.7）。如果满足这4个参数中的至少3个，则阳性似然比增加到12.4。
一组新的IBP标准在已确诊疾病的AS患者中比先前的标准表现更好。需要进行前瞻性研究来验证新候选标准集在早期疾病患者中的诊断性能。
