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 SA | Mechanical LBP | |
---|---|---|
Onset of pain | Insidious | Acute |
Duration of morning stiffness | > 60 min | < 30 min |
Nighttime pain | Yes | Infrequent |
Exercise effect on pain | Improvement | Worsen |
Sacroiliac joint tenderness | Usually | No |
Range of back motion | Global loss of motion | Abnormal flexion |
Reduced chest expansion | Sometimes | No |
Neurologic deficits | No | Possible |
Duration of symptoms | > 3 mo | < 4 wk |
LBP, Low back pain; SA, spinal arthritis.