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New criteria for inflammatory back pain in patients with chronic back pain – a real patient exercise of the Assessment in SpondyloArthritis international Society (ASAS)
  1. J Sieper (joachim.sieper{at}
  1. Charité Universitätsmedizin, Campus Benjamin Franklin, Germany
    1. D M van der Heijde (d.vanderheijde{at}
    1. Leiden University Medical Center, Netherlands
      1. R BM Landewé (r.landewe{at}
      1. University of Maastricht, Netherlands
        1. J Brandt (brandt.rheumatologie{at}
        1. Rheumapraxis Berlin, Germany
          1. R Burgos-Vargas (r.burgos.vargas{at}
          1. Rheumatology Department, Hospital General de Mexico, Universidad Nacional Autonoma de Mexico, Mexico
            1. E Collantes Estévez (ecollantes{at}
            1. Facultad de Medicina, Spain
              1. B AC Dijkmans (secr.reumatologie{at}
              1. Free University Hospital Amsterdam, Netherlands
                1. M Dougados (m.doug{at}
                1. Hopital Cochin Paris, France
                  1. M A Khan (mkhan{at}
                  1. Case Western Reserve University at MetroHealth Medical Center, United States
                    1. M Leirisalo-Repo (marjatta.leirisalo-repo{at}
                    1. Helsinki University Central Hospital, Finland
                      1. S van der Linden (sli{at}
                      1. University Hospital Maastricht, Netherlands
                        1. W P Maksymowych (walter.maksymowych{at}
                        1. University of Alberta, Canada
                          1. H Mielants (herman.mielants{at}
                          1. Gent University Hospital, Belgium
                            1. I Olivieri (ignazioolivieri{at}
                            1. Ospedale S Carlo, Italy
                              1. M Rudwaleit (martin.rudwaleit{at}
                              1. Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany


                                Objective: Inflammatory back pain (IBP) is an important clinical symptom in patients with axial spondyloarthritis (SpA) and relevant for classification and diagnosis. Here we report about a new approach for the development of IBP classification criteria.

                                Methods: Rheumatologists (n=13) who are experts in SpA took part in a two day international workshop to investigate 20 patients with back pain and possible SpA. Each expert documented the presence/ absence of clinical parameters typical for IBP, and judged whether IBP was considered present or absent, based on the evoked information. This expert judgement was used as the dependent variable in a logistic regression analysis in order to identify those individual IBP parameters that contributed best to IBP. The new set of IBP criteria was validated in a separate cohort of patients (n=648).

                                Results: Five parameters explained best IBP according to experts. These were: 1) improvement with exercise (odds ratio (OR) 23.1); 2) pain at night (OR 20.4); 3) insidious onset (OR 12.7); 4) age at onset <40 years (OR 9.9); and 5) no improvement with rest (OR 7.7). If at least 4 out of these 5 parameters were fulfilled the criteria had a sensitivity of 77.0% and specificity of 91.7% in the workshop patients, and 79.6% and 72.4%, respectively, in the validation cohort.

                                Conclusion: This new approach with real patients defines a set of IBP definition criteria using the expert’s overall judgement on IBP as gold standard. The IBP experts criteria are robust, easy to apply and have a good face validity.

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