title: Evaluation of 2 screening strategies for early identification of patients with axial spondyloarthritis in primary care.
abstract: OBJECTIVE
  To evaluate 2 referral strategies for axial spondyloarthritis (SpA) in patients with chronic low back pain at the primary care level.
  
  
  METHODS
  Referral physicians (n = 259) were randomly assigned to either Strategy 1 or Strategy 2 in order to refer patients with chronic back pain (duration > 3 months), age at onset of back pain < 45 years, and no diagnosis of axial SpA, to a cooperating rheumatologist (n = 43). According to Strategy 1, suitable patients were referred if at least 1 of the following screening criteria was present: inflammatory back pain, HLA-B27, or sacroiliitis detected by imaging. According to Strategy 2, patients were referred if 2 out of 5 criteria were positive: the same 3 criteria from Strategy 1 and additionally a positive family history of ankylosing spondylitis (AS) or a good treatment response to nonsteroidal antiinflammatory drugs. The final diagnosis of the rheumatologist was used as the "gold standard."
  
  
  RESULTS
  In total, 560 consecutively referred patients were included in the analysis. Among 318 patients referred by Strategy 1, 41.8% (95% CI 36.5%-47.3%) were diagnosed with definite axial SpA. Among 242 patients referred by the second strategy, definite axial SpA was diagnosed in 36.8% (95% CI 31.0%-43.0%) of the cases.
  
  
  CONCLUSIONS
  Both referral strategies demonstrated comparable performance in identification of patients with axial SpA. Strategy 1 might be preferred as an easy and reliable screening method for axial SpA at the primary care level.
authors.affiliation: Department of Rheumatology, Charité – Campus Benjamin Franklin, Berlin, Germany. joachim.sieper@charite.de
authors.forename: Denis
authors.initials: D
authors.lastname: Poddubnyy
authors.forename: Janis
authors.initials: J
authors.lastname: Vahldiek
authors.forename: Inge
authors.initials: I
authors.lastname: Spiller
authors.forename: Beate
authors.initials: B
authors.lastname: Buss
authors.forename: Joachim
authors.initials: J
authors.lastname: Listing
authors.forename: Martin
authors.initials: M
authors.lastname: Rudwaleit
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001416:Back Pain / Q000453:epidemiology*; D015897:Comorbidity; D042241:Early Diagnosis; D005260:Female; D015796:HLA-B27 Antigen / Q000097:blood; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010375:Pedigree; D011320:Primary Health Care / Q000379:methods*; D058566:Sacroiliitis / Q000453:epidemiology; D025241:Spondylarthritis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D013167:Spondylitis, Ankylosing / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D015796:HLA-B27 Antigen