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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 …
Handling editor Prof Josef S Smolen
Contributors MdH performed the analyses and writing of the manuscript. DvdH gave methodological advice and supervised. FVdB helped drafting the research and supervised. All authors contributed to the acquisition and interpretation of data, read, revised and approved the final manuscript.
Funding Unrestricted grants from AbbVie and ReumaNederland (Dutch Rheumatology Association).
Competing interests No, there are no competing interests for any author.
Patient consent for publication Not required.
Ethics approval information Local medical ethics committees approved the study.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Detailed data on patients with an uncertain diagnosis (level of confidence <7) are available upon request.
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