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

作者：Sieper Joachim^*; Srinivasan Shankar; Zamani Omid; Mielants Herman; Choquette Denis; Pavelka Karel; Loft Anne Gitte; Geher Pal; Danda Debashish; Reitblat Tatiana; Cantini Fabrizio; Ancuta Codrina; Erdes Shandor; Raffayova Helena; Keat Andrew; Gaston J S H; Praprotnik Sonja; Vastesaeger Nathan

来源：Annals of the Rheumatic Diseases, 2013, 72(10): 1621-1627.

DOI：10.1136/annrheumdis-2012-201777

• Ankylosing Spondylitis
• Spondyloarthritis
• Treatment

Objective %26lt;br%26gt;To determine which of two referral strategies, when used by referring physicians for patients with chronic back pain (CBP), is superior for diagnosing axial spondyloarthritis (SpA) by rheumatologists across several countries. %26lt;br%26gt;Methods %26lt;br%26gt;Primary care referral sites in 16 countries were randomised (1:1) to refer patients with CBP lasting %26gt;3months and onset before age 45years to a rheumatologist using either strategy 1 (any of inflammatory back pain (IBP), HLA-B27 or sacroiliitis on imaging) or strategy 2 (two of the following: IBP, HLA-B27, sacroiliitis, family history of axial SpA, good response to non-steroidal anti-inflammatory drugs, extra-articular manifestations). The rheumatologist established the diagnosis. The primary analysis compared the proportion of patients diagnosed with definite axial SpA by referral strategy. %26lt;br%26gt;Results %26lt;br%26gt;Patients (N=1072) were referred by 278 sites to 64 rheumatologists: 504 patients by strategy 1 and 568 patients by strategy 2. Axial SpA was diagnosed in 35.6% and 39.8% of patients referred by these respective strategies (between-group difference 4.40%; 95% CI -7.09% to 15.89%; p=0.447). IBP was the most frequently used referral criterion (94.7% of cases), showing high concordance (85.4%) with rheumatologists%26apos; assessments, and having sensitivity and a negative predictive value of %26gt;85% but a positive predictive value and specificity of %26lt;50%. Combining IBP with other criteria (eg, sacroiliitis, HLA-B27) increased the likelihood for diagnosing axial SpA. %26lt;br%26gt;Conclusions %26lt;br%26gt;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.

• 出版日期2013-10