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21-10-2018 | Axial spondyloarthritis | ACR/ARHP 2018 | News

Online self-referral tool could help improve early SpA diagnosis


medwireNews: An online self-referral strategy for axial spondyloarthritis (SpA) could raise awareness of the condition and improve early diagnosis, suggest findings from the OptiRef study.

The research, presented as a poster at the ACR/ARHP Annual Meeting in Chicago, Illinois, USA, showed that the strategy resulted in an axial SpA diagnosis in 19.3% of 181 respondents who had experienced chronic back pain for more than 3 months and were younger than 45 years of age.

This was “clearly higher than the assumed 5% prevalence of axial SpA in patients with chronic back pain,” note the Optimal Referral Strategy for Early Diagnosis of Axial Spondyloarthritis study team.

The online self-referral questionnaire ( was advertised on the Berlin underground system and could be found online. It asked relatable questions that indicated the presence of chronic back pain lasting more than 3 months with symptom onset before 45 years of age and at least one additional SpA parameter, including inflammatory back pain, human leukocyte antigen (HLA)-B27 positivity, and arthritis among others. Based on the responses, a recommendation was made to see a doctor at their clinic.

The performance of the online tool was compared with physician referral of 181 patients using the Berlin referral tool, with criteria comprising chronic back pain lasting more than 3 months with onset before the age of 45 years and at least one of three parameters ─ inflammatory back pain, HLA-B27 positivity, and sacroiliitis on imaging.

A total of 71 (39.2%) patients referred by physicians and 35 (19.3%) in the self-referral group were finally diagnosed by rheumatologists.

Fabian Proft, from Charité Universitätsmedizin Berlin, Germany, who presented the research, pointed out significant differences in the patients who were referred with each approach.

Those referred via the online tool had longer symptom duration (9.2 vs 6.5 years), lower Physician Global Assessment scores (2.5 vs 3.9), were more often female (56.9 vs 44.2%), and less likely to be HLA-B27 positive (20.4 vs 57.5%) and to have elevated C-reactive protein levels (10.0 vs 19.3%).

And the differences in female gender and HLA-B27 negativity between the two diagnostic routes remained significant among patients eventually confirmed to have axial SpA.

Speaking to medwireNews, Proft said that these two factors “constantly came up as two major drivers of longer diagnostic delay,” so individuals with these characteristics may represent a group in whom axial SpA is not being considered by general practitioners or orthopedic surgeons.

By comparison, the patients diagnosed via physician referral were more likely to be male (69.0 vs 48.6%), HLA-B27 positive (90.1 vs 57.1%), and more often had advanced radiographic changes in the sacroiliac joints leading to a radiographic axial SpA diagnosis (56.3 vs 34.3%).

Proft said that the focus should remain on physician–based referral but the online self-referral strategy could be a complementary tool for identifying SpA patients “who are missed somehow and are dissolved in a large population of patients with unspecific back pain.”

He added that this “would work nicely in a large clinic focused on SpA.”

By Lucy Piper

medwireNews is an independent medical news service provided by Springer Healthcare. © 2018 Springer Healthcare part of the Springer Nature group

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