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Screening Process for axSpA Speeds Diagnosis
Investigators found that a 2-part stratified screening process for patients presenting with low back pain can mitigate delays in the diagnosis and treatment of axial spondyloarthritis (axSpA).
The authors reported that adult patients with low back pain who attended a primary care clinic were given a standard clinical screening. Patients who reported having low back pain for more than 3 months and who were under 50 years of age at onset were then referred to a physiotherapist for a comprehensive screening that included testing for HLA-B27. The secondary screening included stratifying patients with inflammatory features as having a low, medium, or high risk of axSpA vs no risk.
The screening process was evaluated for precision against the assessments of patients by a rheumatologist with expertise in axSpA.
A total of 405 patients with a mean age of 36.9 years of age, 55% female, underwent primary and secondary screening; 14.4% of these patients were positive for HLA-B27. The median wait time from the initial to the secondary screening was 15 days.
“The best combination of sensitivity (68%), specificity (90%), positive (80%), and negative (84%) predictive values was evident with the secondary screen,” the investigators found, with 15.6% of patients receiving final diagnosis of axSpA. The rheumatologist assessed the risk of axSpA as none to low for 64.9% of patients and for medium or high risk of axSpA for 35.1%.
For patients with nonradiographic axSpA, the median duration from the onset of back pain to diagnosis was 2 years; for patients with ankylosing spondylitis the duration was 7 years.
“A stratified interprofessional screening process can facilitate rapid diagnosis of persistent LBP, with high precision and accuracy, in patients with axSpA,” the authors concluded.
--Rebecca Mashaw
Reference:
Passalent L, Sundararajan K, Perruccio AV, et al. Bridging the gap between symptom onset and diagnosis in axial spondyloarthritis. Arthritis Care Res. Published online July 15, 2021.
