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Rheumatology Advance Access published online on May 15, 2009
Rheumatology, doi:10.1093/rheumatology/kep119
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Early spondyloarthritis: usefulness of clinical screening

Josef Hermann1, Hildegard Giessauf1, Gottfried Schaffler2, Petra Ofner3 and Winfried Graninger1

1Division of Rheumatology, Department of Internal Medicine,2Department of Radiology and 3Institute for Medical Information, Statistics and Documentation, Medical University of Graz, Graz, Austria

Correspondence to: Josef Hermann, Division of Rheumatology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, A-8036 Graz, Austria. E-mail: josef.hermann{at}medunigraz.at


  Abstract

Objectives. To evaluate the usefulness of clinical parameters in screening for early SpA in patients meeting Calin's criteria for inflammatory back pain (IBP).

Methods. General practitioners used Calin's criteria for IBP to refer patients younger than 45 years to our early SpA clinic. We obtained the patients’ medical history and performed a clinical examination including plain X-rays and magnetic resonance images of all affected areas. Laboratory tests for acute-phase reactants and HLA-B27 were also obtained. Two rheumatologists made a diagnosis of SpA according to the existing criteria.

Results. Of the 92 patients referred, 30 (33%) were diagnosed with SpA and 62 (67%) with a non-inflammatory disorder. Spontaneous awakening night pain, the presence of Calin's criteria for IBP and tenderness of the SI joints (SIJs) were independently associated with SpA. Neck pain and reduced cervical spine sagittal movement occurred mostly with non-inflammatory disease. A history of night pain and improvement of pain with exercise but not with rest, as well as expression of HLA-B27 and abnormal CRP levels were significantly more common in patients with SpA.

Conclusions. Specific clinical symptoms such as spontaneous awakening night pain, cervical pain and tenderness of the SIJs on clinical examination appear useful in screening younger patients with back pain for early SpA.

KEY WORDS: Medical history, Awakening night pain, Cervical pain, Spondyloarthritis, Screening tools

Submitted 1 November 2008; Accepted 15 April 2009


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