Inflammatory back pain is among the common symptoms that lead to it Spondyloarthritis og 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.
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)