Analysis of 24 cases with low back pain misdiagnosed as spondyloarthropathies / 中华风湿病学杂志

ABSTRACT

Objective To explore the misdiagnostic reasons of 24 cases with low back pain misdiagnosed as spondyloarthropathies and to raise the correctness of spondyloarthropathies diagnosis. Methods Using follow-up and counterchecking combined with review medical records, a retrospective analysis of 24 cases misdiagnosed as spondyloarthropathies in our hospital from 2001 to 2005 were done. Results Among the 24 patients misdiagnosed as spondyloarthropathies, 3 had sacral tubulocyst or parathyroid adenoma associated with hyperparathyroidism, 7 patients with benign or malignant tumors had persistent low back pain that aggrevated at night without morning stiffness. The pain could not be relieved by rest or exercise and could not be relieved by administration of multiple nonsteroidal anti-inflammatory drugs (NSAIDs). The final diagnosis of these 24 cases were as follows 4 were malignant tumors (retroperitoneal adipose sarcoma, advanced gastric carcinoma, ovarian papillary epithelioma, acute lymphocytic leukemia), 6 were benign tumors (2 parathyroid adenoma associated with hyperparathyroidism, 1 intraspinal lipoma, 1 intraspinal ependymomas, 1 sacral tubulocyst and intraspinal and 1 schwannoglioma respectively). The other 14 cases were fibromyalgia syndrome (3), osteitis condensans (3), diffuse idiopathic skeletal hyperostosis (2), lubar intervertebral disc protrusion (1), congenital scoliosis (1), Wilson′s disease (1), ochronosis (1), Fanconi′s syndrome (1) and hypophosphatemic rhachiopathy (1). Although 11 patients had presented inflammatory low back pain defined by Calin, only 2 patients satisfied spondyloarthritides as defined by the classification criteria of the European Spondylarthropathy Study Group (ESSG). Conclusion The misdiagnosis of spondyloarthropathy can be improved by way of careful differential diagnosis of low back pain and holding the classification criteria of the European Spondylarthropathy Study Group (ESSG) as guideline.