Deng Xiao Li, Liu Xiang Yuan, Xu Ning
Department of Rheumatology and Immunology, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing 100191, People's Republic of China.
Clin Rheumatol. 2009 Aug;28(8):893-8. doi: 10.1007/s10067-009-1198-8. Epub 2009 May 17.
This study aims to investigate features of different diseases with low back pain misdiagnosed as spondyloarthropathy so as to improve the accuracy of diagnosis for spondyloarthropathy. The clinical and laboratory data of 24 cases misdiagnosed as spondyloarthropathy in recent 3 years were comparatively and retrospectively analyzed. The diagnostic accuracy of the European Spondyloarthropathy Study Group (ESSG) criteria, Amor criteria, and the combination of them in these misdiagnosed cases was also analyzed. The final diagnoses of these 24 cases were listed below: four malignant tumors (retroperitoneal adipose sarcoma, advanced gastric carcinoma, ovarian papillary epithelioma, acute lymphocytic leukemia), six benign tumors (two parathyroid adenoma with hyperparathyroidism, one intraspinal lipoma, intraspinal ependymomas, sacral tubulocyst, and intraspinal schwannoglioma, respectively). The other 14 cases included fibromyalgia syndrome (3), osteitis condensans (3), diffuse idiopathic skeletal hyperostosis (2), lumbar intervertebral disk protrusion (1), congenital scoliosis (1), Wilson's disease (1), ochronosis (1), Fanconi syndrome (1) and hypophosphatemic rachiopathy (1). Among patients with tumor, all except three patients had persistent low back pain without morning stiffness, which aggravated at night and could not be relieved by rest or exercise. The symptoms could not be relieved by administration of multiple nonsteroidal anti-inflammatory drugs. Eleven patients had inflammatory low back pain defined by Calin. Of the total misdiagnosed cases, 54.17-83.33% could be prevented by application of ESSG criteria or Amor criteria, or a combination of them. From the data, we could see that the clinical features of different diseases with low back pain were different from each other and from those of spondyloarthropathy. The various criteria for spondyloarthropathy may be more effective in combination, along with other clinical information like these clinical features.
本研究旨在探讨被误诊为脊柱关节病的不同类型下腰痛疾病的特征，以提高脊柱关节病的诊断准确性。对近3年被误诊为脊柱关节病的24例患者的临床和实验室资料进行了对比回顾性分析。同时分析了欧洲脊柱关节病研究组（ESSG）标准、Amor标准及其联合应用在这些误诊病例中的诊断准确性。这24例患者的最终诊断如下：4例恶性肿瘤（腹膜后脂肪肉瘤、进展期胃癌、卵巢乳头状上皮瘤、急性淋巴细胞白血病），6例良性肿瘤（2例甲状旁腺腺瘤伴甲状旁腺功能亢进、1例脊髓内脂肪瘤、脊髓内室管膜瘤、骶管囊肿、脊髓内神经鞘瘤各1例）。另外14例包括纤维肌痛综合征（3例）、致密性骨炎（3例）、弥漫性特发性骨肥厚（2例）、腰椎间盘突出症（1例）、先天性脊柱侧弯（1例）、肝豆状核变性（1例）、褐黄病（1例）、范科尼综合征（1例）和低磷性佝偻病（1例）。肿瘤患者中，除3例患者外，均有持续性下腰痛，无晨僵，夜间加重，休息或运动不能缓解。多种非甾体抗炎药治疗不能缓解症状。11例患者有Calin定义的炎性下腰痛。在全部误诊病例中，应用ESSG标准、Amor标准或二者联合可预防54.17% - 83.33%的误诊。从这些数据可以看出，不同类型下腰痛疾病的临床特征彼此不同，也与脊柱关节病的临床特征不同。脊柱关节病的各种诊断标准联合应用，再结合这些临床特征等其他临床信息，可能会更有效。
