Inflammatory Back Pain 4/5 (3)

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Inflammatory back pain is among the common symptoms that lead to spondyloarthritis og Ankylosing spondylitis/Ankylosing spondylitis. However, only about 30% of such symptoms develop such a disease (reference: Wang R, 2018). Thus, the benefit (specificity is low but sensitivity is high) is less than previously thought (reference: de Hooge M, 2019); Poddubnyy D, 2018). The criteria for inflammatory back pain are therefore not suitable for making such a diagnosis without additional studies involving a thorough clinical examination, MR and HLA-B27 in the blood.


Inflammatory back pain versus mechanical (degenerative) back pain (Duba AS, 2018):

Inflammatory back painMechanical back pain
Age at onset<40 yearsAll ages
Morning stiffness>60 minutes<30 minutes
Nocturnal painsCommonAbsent
Effect of physical activity/exerciseImprovementAggravation

Criteria for inflammatory back pain

There are at least three versions of criteria for inflammatory back pain: Calin A, 1977, Rudwaleit M, 2006 and ASAS IBP (Sieper J, 2009). These are largely overlapping and include: Symptom onset before the age of 40, duration at least 3 months, improvement in physical activity, no relief from rest, night pains that are relieved when one gets up and moves.

Rudwaleit's definition has the highest specificity (81%, sensitivity 70%) and is reproduced below:

Inflammatory back pain (reference: Rudwaleit M, 2009):

  • Morning stiffness in the back for at least 30 minutes
  • Improvement by physical activity, not to be at rest
  • Wake up in the second half of the night because of pain
  • Alternating pelvic pain (gluteal)

Two sets of criteria for inflammatory back pain;

Calin A criteria 1977 (5 out of 5: Sens 95%, Specs 85% for Ankylosing spondylitis)Sieper J criteria 2009 (4 of 5: sens. 77%, spec. 91,7% for axial SpA)
Debut at the latest at the age of 45Debut under the age of 40
Morning stiffness at least 30 minutesPain at night
Improvement by physical activityImprovement by physical activity
Gradual debutGradual debut
Duration for at least 3 monthsNo improvement from rest



Gran's compendium in rheumatology

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