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ACR: Chronic Back Pain Tied to Axial Spondyloarthritis

New ASAS guidelines, HLAB27, and X-rays up likelihood of diagnosis

MONDAY, Nov. 8 (HealthDay News) -- Chronic lower back pain might be associated with axial spondyloarthritis, a recently defined form of inflammatory arthritis, according to a study presented at the annual meeting of the American College of Rheumatology, held from Nov. 7 to 11 in Atlanta.

To determine the prevalence of axial spondyloarthritis, Jolanda Luime, Ph.D., of the Erasmus Medical Center in the Netherlands, and colleagues evaluated 364 primary care patients (43 percent male) who had been experiencing chronic lower back pain symptoms for an average of nine years. Participants completed a questionnaire and underwent a full physical examination and blood testing for HLAB27 and C-reactive protein.

Using the Assessment of Spondyloarthritis (ASAS) International Society criteria, the investigators diagnosed 77 participants (21.5 percent) with axial spondyloarthritis. Fifty-two were diagnosed using magnetic resonance imaging with one other feature of spondyloarthritis, 28 were diagnosed with X-ray and the presence of one other spondyloarthritis symptom, and 12 were diagnosed with a positive HLAB27 test and two other spondyloarthritis features. Overall, 6.6 percent of the participants were diagnosed with the more stringent diagnosis of ankylosing spondylitis. Compared to the currently accepted criteria using conventional X-ray alone, the investigators found that three times as many patients were diagnosed with the condition using the new ASAS criteria. The addition of HLAB27 testing and X-rays increased the likelihood of diagnosis.

"The study confirms that there is a direct link between chronic lower back pain and spondyloarthritis," study co-author Angelique Weel, M.D., of the Maasstadziekenhuis Rotterdam in the Netherlands, said in a statement. "Such patients diagnosed by primary care physicians could be helped early in their disease by referral to a rheumatologist."

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