Department of Medicine, University of Alberta, 562 Heritage Medical Research Center, Edmonton, Alberta T6G 2S2, Canada.
J Rheumatol. 2012 Apr;39(4):822-9. doi: 10.3899/jrheum.110537. Epub 2012 Feb 15.
Inflammatory back pain (IBP) is an important feature of axial spondyloarthritis (SpA) that is poorly recognized in primary care, perhaps delaying diagnosis of SpA. We aimed to develop and validate a self-report questionnaire using important domains reported by patients with IBP.
We developed a 6-item questionnaire assessing spinal/hip stiffness, nocturnal pain, diurnal variation, effects of exercise/rest, and peripheral joint pain/swelling. This was compared with the Calin questionnaire and the domains comprising the Assessment of Spondyloarthritis International Society (ASAS) criteria for IBP in 220 patients with established axial SpA and 66 patients with mechanical back pain followed in tertiary care rheumatology clinics. The classification utility of each item was evaluated using sensitivity, specificity, and likelihood ratio (LR). Multivariable logistic regression was used to analyze different combinations of items to develop candidate scoring systems.
The single item "diurnal variation" had the highest combination of sensitivity (49%) and specificity (92%) for IBP (positive LR 5.95, 95% CI 2.54-13.94), outperforming the Calin and ASAS IBP criteria, which had sensitivities of 83% and 59%, specificities 42% and 66%, positive LR 1.42 and 1.72, negative LR 0.41 and 0.62, respectively. Classification utility of this item was even higher in SpA patients with disease duration < 6 years (sensitivity 48%, specificity 96%, positive LR 12, negative LR 0.54). The other 5 items did not improve classification utility in any combination.
Assessment of a single self-reported item, "diurnal variation," had substantial classification utility for IBP. This domain is not addressed in existing criteria for IBP, indicating a potentially important omission.
炎症性背痛（IBP）是轴性脊柱关节炎（SpA）的一个重要特征，但在初级保健中认识不足，可能会延迟 SpA 的诊断。我们旨在开发和验证一种使用 IBP 患者报告的重要领域的自我报告问卷。
我们开发了一个包含 6 个项目的问卷，评估脊柱/臀部僵硬、夜间疼痛、日间变化、运动/休息的影响以及外周关节疼痛/肿胀。在三级保健风湿病诊所随访的 220 例已确诊的轴性 SpA 患者和 66 例机械性背痛患者中，将其与 Calin 问卷和构成 ASAS 炎症性背痛标准的领域进行比较。使用灵敏度、特异性和似然比（LR）评估每个项目的分类效用。多变量逻辑回归用于分析不同项目组合以开发候选评分系统。
“日间变化”这一单项具有最高的 IBP 敏感性（49%）和特异性（92%）（阳性 LR 5.95，95%CI 2.54-13.94），优于 Calin 和 ASAS IBP 标准，其敏感性分别为 83%和 59%，特异性分别为 42%和 66%，阳性 LR 分别为 1.42 和 1.72，阴性 LR 分别为 0.41 和 0.62。在疾病持续时间<6 年的 SpA 患者中，该项目的分类效用更高（敏感性 48%，特异性 96%，阳性 LR 12，阴性 LR 0.54）。其他 5 个项目在任何组合中均未提高分类效用。
评估单个自我报告项目“日间变化”对 IBP 具有很大的分类效用。这一领域在现有的 IBP 标准中没有涉及，表明存在一个潜在的重要遗漏。
