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PC0007 Inflammatory low back pain features at primary care
  1. L. Myasoutova,
  2. S. Lapshina,
  3. M. Protopopov,
  4. S. Erdes
  1. Kazan State Medical University, Kazan, Russian Federation

Abstract

Background Low back pain is among the most frequent reasons for seeking medical care. Low back pain (LBP) of inflammatory origin deserves special interest as it can be a manifestation of a spondyloarthropathy (SpA). If a patient presents with LBP, diagnostic algorithm is quite complex.

Objectives To evaluate incidence and features of rheumatic diseases in patients with inflammatory LBP (ILBP).

Methods All patients (65 patients, male - 55, female - 10, mean age 32±8,1 years) without define diagnosis and with ILBP according to ASAS criteria, who were referred to rheumatologist in Kazan municipal rheumatology center from October 2010 to April 2011, were included in the study. Work-up included physical examination, medical history, HLA-B27 detection, laboratory finings (ESR, CRP), X-ray of lumbar spine and sacroiliac joints, magnetic resonance imaging (MRI) of lumbar spine and sacroiliac joints, (1,5T, T1 and STIR). The number of patients with established diagnosis of ankylosing spondylitis (AS), psoriatic arthritis (PsA), axial and peripheral spondyloartropathy (SpA) and reactive spondyloartropathy (ReSpA) were analysed.

Mean duration of LBP was 3,3±1,4 years, mean VAS score of LBP was 54±14, BASDAI score - 4,1±1,2. HLA-B27 was detected in 42 patients, sacroiliitis (filfilling the radiologic criterion for AS) was found to be present in 17 patients. 35 patients had inflammatory lesions on MRI, 18 patients had peripheral arthritis.

Results The following diagnoses were set up according to actual criteria: AS - 17 patients, PsA - 6 patients, ReSpA - 7 patients, axial SpA - 18, peripheral SpA - 2 patients. In 15 patients ILBP was the only clinical feature.

Conclusions In 77% of cases ILBP was a manifestation of a form of SpA (including AS, PsA, ReSpA), requiring appropriate use of those criteria by primary care doctors for a timely diagnosis. Still, in a number o cases it can be the only clinical manifestation and patients do not fulfill criteria for any form of SpA. Those patients should be monitored closely.

Disclosure of Interest None Declared

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