Comparison of two referral strategies for diagnosis of axial spondyloarthritis: the Recognising and Diagnosing Ankylosing Spondylitis Reliably (RADAR) study

Sieper, Joachim; Srinivasan, Shankar; Zamani, Omid; Mielants, Herman; Choquette, D.; Pavelka, Karel; Loft, Anne Gitte; Géher, Pál; Danda, Debashish; Reitblat, Tatiana; Cantini, Fabrizio; Ancuta, C.; S, Erdesz; Raffayová, Helena; Keat, Andrew; Gaston, J. S. H.; Praprotnik, Sonja; Vastesaeger, Nathan

doi:10.1136/annrheumdis-2012-201777

Cited by 100 publications

(81 citation statements)

References 22 publications

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“…Only 24 patients overall (6.6%) satisfied the criteria for radiographic axSpA [4]. In studies of patients with suspected axSpA who were referred to rheumatologists for diagnosis, the proportion of patients identified as having non-radiographic axSpA among newly diagnosed axSpA patients ranged from 23% to 80% [5,[17][18][19][20][21][22][23][24]. This wide range of frequencies reflects differences in the studies' patient populations and methodologies (e.g., eligibility criteria).…”

Section: Frequency Of Spa In Epidemiological Studiesmentioning

confidence: 99%

The burden of non-radiographic axial spondyloarthritis

Boonen

Sieper

Heijde

et al. 2015

Seminars in Arthritis and Rheumatism

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Section: Frequency Of Spa In Epidemiological Studiesmentioning

confidence: 99%

The burden of non-radiographic axial spondyloarthritis

Boonen

Sieper

Heijde

et al. 2015

Seminars in Arthritis and Rheumatism

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120

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“…At the same time, such a ‘filter’ (further called ‘referral strategy’) should not be too complex in order to make its application feasible by all type of doctors. While several referral strategies2 3 5–9 have been proposed and tested over the last 10 years, to date a universally accepted referral strategy is still lacking. In this work, we aim to summarise existing data concerning referral strategies for patients suspected of having axSpA and to develop a consensual Assessment of SpondyloArthritis international Society (ASAS)-endorsed recommendation for early referral of this group.…”

mentioning

confidence: 99%

Development of an ASAS-endorsed recommendation for the early referral of patients with a suspicion of axial spondyloarthritis

et al. 2015

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The aim of this work was to develop a consensual recommendation under the auspices of the Assessment of SpondyloArthritis international Society (ASAS) for early referral of patients with a suspicion of axial spondyloarthritis by non-rheumatologists. The development of a referral recommendation consisted of four phases: (1) systematic literature review, (2) the first Delphi round aiming at identification of unmet needs and development of a candidate list of referral parameters, (3) the second Delphi round aiming at identification of the most useful combination of referral parameters and (4) final discussion and formal endorsement by ASAS membership. The following consensus on a referral recommendation was achieved as a result of the Delphi processes and final voting: "Patients with chronic back pain (duration ≥3 months) and back pain onset before 45 years of age should be referred to a rheumatologist if at least one of the following parameters is present: Inflammatory back pain; human leucocyte antigen-B27; Sacroiliitis on imaging if available (X-rays or magnetic resonance imaging); Peripheral manifestations (arthritis, enthesitis, dactylitis); Extra-articular manifestations (psoriasis, inflammatory bowel disease, uveitis); Positive family history for spondyloarthritis; Good response to non-steroidal anti-inflammatory drugs; Elevated acute phase reactant." A consensual ASAS-endorsed referral recommendation for patients suspected of having axial spondyloarthritis was developed as a flexible and universal strategy to be used in clinical practice by primary care physicians or non-rheumatology specialists. The practical value of this strategy applied in different settings should be determined in future studies.

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“…Data from eight studies performed in patients with suspected axSpA with a wide range of symptom duration (<2 to >7 years) indicates that the proportion of nr-axSpA patients among those with newly diagnosed axSpA is between 23-80 % [8,[11][12][13][14][15][16][17][18]. The wide variation may be due to differences in symptom duration and other parameters such as interpretation of MRI results [12].…”

Section: Natural History Of Nonradiographic Axial Spamentioning

confidence: 99%

Nonradiographic axial spondyloarthritis background and confounding factors of this new terminology: an appraisal

Erbil

Espinoza

2014

Clin Rheumatol

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The advent of biologic therapy in the treatment of rheumatic diseases has intensified the need to further define and characterize spondyloarthritis (SpA). There has been a long debate over nomenclature of the SpA subtypes. There are those who are considered "lumpers," favoring the notion that different entities of the SpA groups are manifestations of the same disease, and "splitters," those who believe the different SpA groups represent separate diseases with shared clinical features. The influential work by Moll et al. has led to separation of entities and recognition of etiological processes of SpA subtypes. Among these subtypes has emerged nonradiographic axial spondyloarthritis (nr-axSpA), which is believed to be either an early form of ankylosing spondylitis (AS) or perhaps a different disease entity altogether. Recently attention has shifted to the characterization of early SpA, with special emphasis on nonradiographic axial SpA. The Assessment of Spondyloarthritis International Society (ASAS) has developed new criteria for the classification of this disease entity. Along with the advent of these criteria have come several unanswered questions. Although data suggests that nr-axSpA will evolve into AS over time, the natural evolution of disease is still undetermined since a proportion of cases do not progress. A number of questions also remain regarding features of patients with AS compared to those with nonradiographic disease. This appraisal highlights the differences in disease characteristics between men and women in regards to measures of disease activity, inflammatory markers, and radiologic findings. Recent studies also suggest fibromyalgia as a potential confounding factor in assessing disease activity and establishing a diagnosis of axSpA in the female population. Nonradiographic axial SpA is a relevant disease subgroup of axial SpA, and several questions have been left unanswered with more research needed regarding diagnosis (particularly in women), treatment, and long-term disease course.

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Comparison of two referral strategies for diagnosis of axial spondyloarthritis: the Recognising and Diagnosing Ankylosing Spondylitis Reliably (RADAR) study

Abstract: A referral strategy based on three criteria leads to a diagnosis of axial SpA in approximately 35% of patients with CBP and is applicable across countries and geographical locales with presumably different levels of expertise in axial SpA.

Cited by 100 publications

References 22 publications

The burden of non-radiographic axial spondyloarthritis

The burden of non-radiographic axial spondyloarthritis

Development of an ASAS-endorsed recommendation for the early referral of patients with a suspicion of axial spondyloarthritis

Nonradiographic axial spondyloarthritis background and confounding factors of this new terminology: an appraisal

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