PMID- 17456526
OWN - NLM
STAT- MEDLINE
DCOM- 20071109
LR  - 20220409
IS  - 0003-4967 (Print)
IS  - 1468-2060 (Electronic)
IS  - 0003-4967 (Linking)
VI  - 66
IP  - 11
DP  - 2007 Nov
TI  - Performance of referral recommendations in patients with chronic back pain and 
      suspected axial spondyloarthritis.
PG  - 1479-84
AB  - BACKGROUND: Ankylosing spondylitis (AS) and its early form account for up to 5% 
      of all patients with chronic back pain. Interest has recently focused on 
      shortening the delay of 5-10 years between the appearance of first symptoms and 
      the diagnosis of AS, particularly because effective treatments have now become 
      available. Referral parameters that are easy for doctors in primary care to apply 
      to patients presenting with possible AS could contribute to earlier diagnosis. 
      METHODS: Orthopaedists and primary-care doctors were requested to refer patients 
      with (1) chronic low back pain (duration >3 months) and (2) onset of back pain 
      before <45 years of age to a specialist rheumatology outpatient clinic for 
      further diagnostic investigation if at least one of the following screening 
      parameters was present: (1) inflammatory back pain, (2) positive human leucocyte 
      antigen B27, and (3) sacroiliitis detected by imaging. The final diagnosis was 
      made according to expert opinion. RESULTS: In total, 350 referred cases were 
      analysed. A diagnosis of definite axial spondyloarthritis (axial SpA), comprising 
      established AS and pre-radiographic axial SpA, could be made in 45.4% of all 
      referred patients (of which 50.3% were classified as AS and 49.7% as 
      preradiographic axial SpA), whereas 45.4% were classified as non-SpA and 9.1% as 
      possible SpA. A diagnosis of definite axial SpA could be made in 34.2% if only 
      one referral parameter was positive, and in 62.6% if there was >1 positive 
      referral parameter. CONCLUSIONS: The proposed referral parameters have proven 
      useful when applied in primary care in identifying patients with 
      AS/pre-radiographic axial SpA among young to middle-aged patients with chronic 
      low back pain.
FAU - Brandt, Henning Christian
AU  - Brandt HC
AD  - Rheumatology, Department of Medicine I, Charite Campus Benjamin Franklin, Berlin, 
      Germany.
FAU - Spiller, Inge
AU  - Spiller I
FAU - Song, In-Ho
AU  - Song IH
FAU - Vahldiek, Janis L
AU  - Vahldiek JL
FAU - Rudwaleit, Martin
AU  - Rudwaleit M
FAU - Sieper, Joachim
AU  - Sieper J
LA  - eng
PT  - Evaluation Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20070424
PL  - England
TA  - Ann Rheum Dis
JT  - Annals of the rheumatic diseases
JID - 0372355
RN  - 0 (Biomarkers)
RN  - 0 (HLA-B27 Antigen)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - *Axis, Cervical Vertebra
MH  - Biomarkers/analysis
MH  - Chronic Disease
MH  - Early Diagnosis
MH  - Female
MH  - Germany
MH  - HLA-B27 Antigen/analysis
MH  - Humans
MH  - Low Back Pain/*etiology
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Mass Screening/methods
MH  - Middle Aged
MH  - Outpatient Clinics, Hospital
MH  - Patient Selection
MH  - Primary Health Care/methods/standards
MH  - Referral and Consultation/*standards
MH  - Spondylarthritis/complications/*diagnosis
MH  - Spondylitis, Ankylosing/complications/diagnosis
MH  - Time Factors
PMC - PMC2111623
EDAT- 2007/04/26 09:00
MHDA- 2007/11/10 09:00
PMCR- 2010/11/01
CRDT- 2007/04/26 09:00
PHST- 2007/04/26 09:00 [pubmed]
PHST- 2007/11/10 09:00 [medline]
PHST- 2007/04/26 09:00 [entrez]
PHST- 2010/11/01 00:00 [pmc-release]
AID - ard.2006.068734 [pii]
AID - ar68734 [pii]
AID - 10.1136/ard.2006.068734 [doi]
PST - ppublish
SO  - Ann Rheum Dis. 2007 Nov;66(11):1479-84. doi: 10.1136/ard.2006.068734. Epub 2007 
      Apr 24.