Identifying patients with axial spondyloarthritis in primary care: how useful are items indicative of inflammatory back pain?

摘要

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 < 45 years (n=950) with back pain for > 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 /= 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.