Inflammatory spinal arthritis versus mechanical low back pain in IBD

Which points in the history and physical examination are helpful in separating inflammatory spinal arthritis from mechanical low back pain in an IBD patient? 

On the basis of history and physical examination, 90% of patients with inflammatory spinal arthritis can be differentiated from patients with mechanical low back pain.

Clinical Differentiation of Inflammatory Spinal Arthritis and Mechanical Low Back Pain

Inflammatory SAMechanical LBP
Onset of painInsidiousAcute
Duration of morning stiffness> 60 min< 30 min
Nighttime painYesInfrequent
Exercise effect on painImprovementWorsen
Sacroiliac joint tendernessUsuallyNo
Range of back motionGlobal loss of motionAbnormal flexion
Reduced chest expansionSometimesNo
Neurologic deficitsNoPossible
Duration of symptoms> 3 mo< 4 wk

LBP, Low back pain; SA, spinal arthritis.


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