Background/Purpose: Inflammatory low back pain (IBP) is the important presenting symptom in patients with axial spondyloarthritis (axSpA). Three criteria sets for IBP are frequently assessed in terms of discriminative ability from mechanical LBP, however the gender specific discriminative value of these criteria sets has not been investigated yet. Therefore the aim of this study was to evaluate gender differences in discriminative value of IBP criteria in a patient population of axial spondyloarthritis and non-spondyloarthritis chronic low back pain.

Methods:  Adult patients with a history of chronic LBP (> 3 months) and age of onset less than 45 years were screened for ASAS criteria for axial spondyloarthritis (axSpA). Those who were between 18-50 years and met the axSpA criteria were assigned as axSpA group and those who did not met these criteria were assigned as non-SpA chronic LBP group. All of the patients were also screened for the items of IBP criteria according to the Calin, Berlin and ASAS criteria definitions. Receiver operating characteristic (ROC) curve analysis were performed for all the separate items and the criteria as a whole in both male and female patient groups. Area under the curve (AUC) were calculated for each item and criteria sets and statistically compared by using the De Long method.

Results: A total of 136 patients (59 women) with axSpA and 111 patients (48 women) with non-SpA LBP were included. In women, AUC was the highest for insidious onset 0.94 (95% CI 0.88-0.98), followed by alternating buttock pain 0.82, improvement with exercise 0.74, no improvement with rest 0.72, age at onset ≤ 40 years 0.68, morning stiffness > 30 min 0.67, improvement with exercise/not rest 0.66, morning stiffness 0.65, and awakening (second half of the night) because of pain 0.62 with the least value. In men, AUC was the highest for insidious onset 0.87 (95% CI 0.80-0.92), followed by morning stiffness 0.78, no improvement with rest 0.77, alternating buttock pain 0.75, improvement with exercise 0.698, improvement with exercise/not rest 0.696, morning stiffness > 30 min 0.668, awakening (second half of the night) because of pain 0.63, and age at onset ≤ 40 years 0.51 with the least value. AUC values for items in men were relatively lower than women. Similarly, the AUC values for IBP criteria sets were relatively lower in men compared to women. Also comparison of AUC values revealed that Calin criteria had significantly higher values compared to Berlin and ASAS criteria in both genders.

Conclusion:  The AUC values revealed that discriminative ability of criteria sets were fair to excellent.  All criteria items and sets perform similarly in both genders however criteria items perform relatively better in women than men. Also Calin criteria perfume significantly higher than Berlin and ASAS criteria in both genders.  

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-there-any-gender-specific-difference-in-discriminative-value-of-inflammatory-back-pain-criteria/