Abstract | INTRODUCTION: Chronic back pain (CBP) is frequently the presenting symptom in patients with suspected axial spondyloarthritis ( axSpA). Presence of sacroiliitis on magnetic-resonance-imaging (MRI) or HLA-B27 adds to diagnostic certainty. However, these costly tests cannot be applied in all patients with CBP. This study aims to investigate which SpA features increase the likelihood of a positive HLA-B27 or positive MRI of the sacroiliac-joints (MRI-SI) in patients with suspected axSpA. METHODS: Data from 665 patients with CBP within the ESPeranza Programme were analysed. Diagnostic utility measures (LR+, LR-) for a positive MRI-SI or HLA-B27 were calculated for various definitions of inflammatory back pain ( IBP), their separate items and for other SpA features. RESULTS: Pretest probabilityies of a positive result was 41% for MRI-SI and 40% for HLA-B27. For a positive MRI-SI result the most useful IBP characteristic was alternating buttock pain (LR + =2.6). Among the IBP-criteria, fulfillment of the 'ASAS criteria' (LR + =2.1) was most contributory. Interestingly, the addition of alternating buttock pain to the Calin/ASAS- IBP criteria (LR + =6.0 and 5.5, respectively) or the addition of awakening at second half of night to the Calin- IBP criteria (LR + =5.5) increased the pre-test probability of MRI- sacroiliitis from 41% to 79-80%. Dactylitis (LR + =4.1) and inflammatory bowel disease (IBD) (LR + =6.4) increased this probability to 73% and 81%, respectively. To forecast HLA-B27 positivity, awakening at the second half of the night, fulfillment of the ASAS- IBP definition and uveitis were the most useful, but only marginally predictive (LR + = 1.3, 1,6 and 2.6, respectively). CONCLUSIONS: If patients with suspected axial SpA have either (1) IBP according to Calin/ASAS definition plus alternating buttock pain, or (2) IBP according to Calin definition plus awakening at night, or (3) dactylitis or 4) IBD, the probability of finding a positive MRI-SI increases significantly.
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Authors | Victoria Navarro-Compán, Eugenio de Miguel, Désirée van der Heijde, Robert Landewé, Raquel Almodóvar, Carlos Montilla, Emma Beltrán, Pedro Zarco |
Journal | Arthritis research & therapy
(Arthritis Res Ther)
Vol. 17
Pg. 265
(Sep 23 2015)
ISSN: 1478-6362 [Electronic] England |
PMID | 26395086
(Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
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Chemical References |
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Topics |
- Adolescent
- Adult
- Back Pain
(complications, diagnosis, physiopathology)
- Chronic Disease
- Cohort Studies
- Cross-Sectional Studies
- Female
- HLA-B27 Antigen
(analysis)
- Humans
- Inflammatory Bowel Diseases
(complications, diagnosis, physiopathology)
- Magnetic Resonance Imaging
(methods)
- Male
- Middle Aged
- Radiography
- Reproducibility of Results
- Sacroiliac Joint
(diagnostic imaging)
- Sacroiliitis
(complications, diagnosis, physiopathology)
- Sensitivity and Specificity
- Spondylitis, Ankylosing
(complications, diagnosis, physiopathology)
- Young Adult
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