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Back Pain in Psoriatic Arthritis

A single center study of psoriatic arthritis patients has shown that rheumatologist-judged inflammatory back pain (IBP) and criteria defining IBP may not perform well when ascertaining axial involvement in PsA patients. 

Using prospective clinic data and clinical assessments in a cohort of PsA patients, 171 patients (52% male, mean age 46.6 years) were studied. More than half (56%) reported chronic back pain.  Inflammatory back was either rheumatologist defined or defined by one of 3 accepted criteria for IBP (Calin, Rudwaleit, ASAS).

Inflammatory back pain was seen in 38% of patients and 32% had evidence of radiological changes in the spine.

The agreement between rheumatologist judgement of IBP and criteria used for IBP was highest for the Calin criteria (0.70).

Rudwaleit criteria for IBP (2.17) had the highest positive likelihood ratio for radiological axial involvement.

Amongst AxPsA with or without back pain, those with back pain had higher BASDAI scores and lower frequency of HLA-B*38 .

IBP as judged by the rheumatologist does not always agree with IBP criteria, nor will all have xrays changes of spondylitis.

The author has no conflicts of interest to disclose related to this subject

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