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Inflammatory back pain (IBP) is considered so essential in the axial spondyloarthritis (axSpA) diagnostic process that it is recommended as referral parameter in primary care.1–3 However, axSpA patients without IBP do exist as well as patients with IBP that do not have an axSpA diagnosis, leaving IBP to be a strong and useful feature for recognising axSpA but not pathognomonic.4 5 A recent study in German chronic back pain patients with a suspicion of axSpA report on the performance of, among others, the Assessment of Spondyloarthritis international Society (ASAS) IBP criteria and individual IBP parameters. Data showed high sensitivity of the criteria and individual IBP parameters, however specificity was low.6 Important findings like low specificity indicate that in the German rheumatology setting diagnostic utility of IBP criteria was lower than expected. In addition, they commonly find IBP in patients in routine rheumatology care, suggesting that IBP is used as …
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