Identifying patients with axial spondyloarthritis in primary care: how useful are items indicative of inflammatory back pain?
Open Access
- 5 August 2011
- journal article
- research article
- Published by BMJ in Annals Of The Rheumatic Diseases
- Vol. 70 (10), 1782-1787
- https://doi.org/10.1136/ard.2011.151167
Abstract
Background The value of clinical items defining inflammatory back pain to identify patients with axial spondyloarthritis (SpA) in primary care is unclear. Objective To identify predictive clinical parameters for a diagnosis of axial SpA in patients with chronic back pain presenting in primary care. Methods Consecutive patients aged 2 months who presented to orthopaedic surgeons (n=143) were randomised based on four key questions for referral to rheumatologists (n=36) for diagnosis. Results The rheumatologists saw 322 representative patients (mean age 36 years, 50% female, median duration of back pain 30 months). 113 patients (35%) were diagnosed as axial SpA (62% HLA B27+), 47 (15%) as ankylosing spondylitis (AS) and 66 (21%) as axial non-radiographic SpA (nrSpA). Age at onset ≤35 years, improvement by exercise, improvement with non-steroidal anti-inflammatory drugs, waking up in the second half of the night and alternating buttock pain were identified as most relevant for diagnosing axial SpA by multiple regression analysis. Differences between AS and nrSpA were detected. No single item was predictive, but ≥3 items proved useful for good sensitivity and specificity by receiver operating characteristic modelling. Conclusion This study shows that a preselection in primary care of patients with back pain based on a combination of clinical items is useful to facilitate the diagnosis of axial SpA.Keywords
This publication has 34 references indexed in Scilit:
- Contribution of myeloid dendritic cells to type I interferon-induced cytokines and chemokinesArthritis & Rheumatism, 2010
- The enigmatic role of IL-12 in the pathogenesis of Sjögren's syndrome: Comment on article by Vosters J.L. et alArthritis & Rheumatism, 2010
- Inflammatory and degenerative sacroiliac joint disease in a primary back pain cohortArthritis Care & Research, 2010
- The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selectionAnnals Of The Rheumatic Diseases, 2009
- Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part IArthritis & Rheumatism, 2007
- Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritisAnnals Of The Rheumatic Diseases, 2007
- Classification of inflammatory arthritis by enthesitisThe Lancet, 1998
- PROFILE OF HLA-B27-RELATED ‘UNCLASSIFIABLE’ SERONEGATIVE SPONDYLOARTHROPATHY IN FEMALES AND ITS COMPARISON WITH THE PROFILE IN MALESRheumatology, 1995
- An epidemiological survey of the signs and symptoms of ankylosing spondylitisClinical Rheumatology, 1985
- Evaluation of Diagnostic Criteria for Ankylosing SpondylitisArthritis & Rheumatism, 1984