Rudwaleit et al developed criteria for the diagnosis of inflammatory back pain (due to ankylosing spondylitis) in a young to middle-aged adult with chronic back pain. This can help distinguish the back pain of ankylosing spondylitis from other forms of back pain, which can help direct therapy. The authors are from Campus Benjamin Franklin in Berlin, the German Rheumatology Research Centre, and the Rheumazentrum Ruhrgebiet in Herne, Germany.
Patient selection: adult <= 50 years of age with chronic back pain
Parameters:
(1) duration of morning stiffness
(2) improvement in back pain
(3) awakening because of back pain at night
(4) buttock pain
Parameter
Finding
Points
duration of morning stiffness
<= 30 minutes
0
> 30 minutes
1
improvement in back pain
with exercise but not rest
1
with rest
0
no improvement
0
awakening because of back pain at night
in second half of the night only
1
in first half of night
0
none
0
buttock pain
alternating
1
none or non-alternating
0
where:
• The morning stiffness was not specified as being limited to the back or involving other joints.
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• A score >= 2 was used to identify a patient with probably inflammatory back pain.
Performance of the criteria:
• The sensitivity was 70% and specificity 81%.
• The positive likelihood ratio was 3.7.
• The use of a cutoff >=3 had a higher specificity (97%) but low sensitivity (34%).
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