How to screen for axial spondyloarthritis in primary care?

Purpose of reviewThere is a major delay of several years between first symptoms and making a diagnosis in patients with axial spondyloarthritis. A strategy for earlier diagnosis is urgently needed, for which efficient referral parameters applicable in primary care are an important part. Published studies on referral programs are reviewed and their relevance for daily clinical practice is discussed. ResultsSeveral referral investigations have been performed in several countries using the symptom of ‘inflammatory back pain’ (IBP) alone or in combination with other referral parameters. All studies performed resulted in a good and acceptable percentage of an axial SpA diagnosis in between 29 and 58%. A set of rather simple parameters (IBP and/or HLA-B27 positivity and/or sacroiliitis on imaging) performed better than IBP alone and is easier to use than more complicated referral strategies. SummaryReferral strategies to screen for axial SpA patients in primary care are available, are effective and should be applied more regularly.

[1]  J. Listing,et al.  Evaluation of 2 Screening Strategies for Early Identification of Patients with Axial Spondyloarthritis in Primary Care , 2011, The Journal of Rheumatology.

[2]  J. Grifka,et al.  Identifying patients with axial spondyloarthritis in primary care: how useful are items indicative of inflammatory back pain? , 2011, Annals of the rheumatic diseases.

[3]  Andreas Krause,et al.  Effects of etanercept versus sulfasalazine in early axial spondyloarthritis on active inflammatory lesions as detected by whole-body MRI (ESTHER): a 48-week randomised controlled trial , 2011, Annals of the rheumatic diseases.

[4]  W. Graninger,et al.  Early spondyloarthritis: usefulness of clinical screening. , 2009, Rheumatology.

[5]  D. M. van der Heijde,et al.  Defining active sacroiliitis on magnetic resonance imaging (MRI) for classification of axial spondyloarthritis: a consensual approach by the ASAS/OMERACT MRI group , 2009, Annals of the rheumatic diseases.

[6]  L. Coates,et al.  Clinical and imaging efficacy of infliximab in HLA-B27-Positive patients with magnetic resonance imaging-determined early sacroiliitis. , 2009, Arthritis and rheumatism.

[7]  M. Dougados,et al.  The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection , 2009, Annals of the rheumatic diseases.

[8]  M. Dougados,et al.  New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS) , 2009, Annals of the rheumatic diseases.

[9]  J. Braun,et al.  Efficacy of adalimumab in the treatment of axial spondylarthritis without radiographically defined sacroiliitis: results of a twelve-week randomized, double-blind, placebo-controlled trial followed by an open-label extension up to week fifty-two. , 2008, Arthritis and rheumatism.

[10]  J. Sieper,et al.  Performance of referral recommendations in patients with chronic back pain and suspected axial spondyloarthritis , 2007, Annals of the rheumatic diseases.

[11]  J. Braun,et al.  Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. , 2006, Arthritis and rheumatism.

[12]  J. Sieper,et al.  The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? , 2005, Arthritis and rheumatism.

[13]  J. Sieper,et al.  Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care , 2004, Annals of the rheumatic diseases.

[14]  D. M. van der Heijde,et al.  How to diagnose axial spondyloarthritis early , 2004, Annals of the rheumatic diseases.

[15]  Jürgen Braun,et al.  Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis , 2003, Rheumatology International.

[16]  M. Underwood,et al.  Inflammatory back pain in primary care. , 1995, British journal of rheumatology.

[17]  A. Calin,et al.  Clinical history as a screening test for ankylosing spondylitis. , 1977, JAMA.

[18]  E. L. Persons,et al.  Ankylosing Spondylitis , 1955, GP.