title: Reccomendations for the detection, study and referral of inflammatory low-back pain in primary care.
abstract: OBJECTIVE
  To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians.
  
  
  METHODS
  We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round.
  
  
  RESULTS
  We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests.
  
  
  CONCLUSIONS
  The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.
authors.affiliation: Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, España; Institut d'Investigació Biomédica de Bellvitge, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER.
authors.forename: Xavier
authors.initials: X
authors.lastname: Juanola Roura
authors.affiliation: Instituto Maimónides de Investigación Biomédica de Córdoba,, Córdoba, España; Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, España; Universidad de Córdoba, Córdoba, España; Grupo de Estudio de las Espondiloartritis de la SER.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Collantes Estévez
authors.affiliation: Centro de Salud Universitario San Juan de la Cruz, Pozuelo de Alarcón, Madrid, España.
authors.forename: Fernando
authors.initials: F
authors.lastname: León Vázquez
authors.affiliation: Centro de Salud Arroyo de la Media Legua, Servicio Madrileño de Salud, Madrid, España.
authors.forename: Antonio
authors.initials: A
authors.lastname: Torres Villamor
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, España.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: García Yébenes
authors.affiliation: Hospital Universitario Central de Asturias, Oviedo, Asturias, España; Grupo de Estudio de las Espondiloartritis de la SER.
authors.forename: Rubén
authors.initials: R
authors.lastname: Queiro Silva
authors.affiliation: Hospital Parc Taulí, Sabadell, Barcelona, España; Grupo de Estudio de las Espondiloartritis de la SER.
authors.forename: Jordi
authors.initials: J
authors.lastname: Gratacós Masmitja
authors.affiliation: Unidad de Gestión Clínica Fuensanta, Córdoba, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP).
authors.forename: Emilio
authors.initials: E
authors.lastname: García Criado
authors.affiliation: Unidad de Gestión Clínica Limonar, Málaga, España; Sociedad Española de Médicos de Atención Primaria (SEMERGEN-AP).
authors.forename: Sergio
authors.initials: S
authors.lastname: Giménez
authors.affiliation: Instituto de Salud Musculoesquelética, Madrid, España. Electronic address: loreto.carmona@inmusc.eu.
authors.forename: Loreto
authors.initials: L
authors.lastname: Carmona
mesh_terms: D000328:Adult; D000465:Algorithms; D059350:Chronic Pain / Q000209:etiology; D000066491:Clinical Decision-Making; D003661:Decision Support Techniques; D003697:Delphi Technique; D042241:Early Diagnosis; D006801:Humans; D017116:Low Back Pain / Q000209:etiology*; D008159:Lumbar Vertebrae; D008875:Middle Aged; D011320:Primary Health Care; D012017:Referral and Consultation; D012219:Rheumatology; D025241:Spondylarthritis / Q000150:complications / Q000175:diagnosis*
keywords: Atención Primaria; Derivación; Dolor lumbar inflamatorio; Espondiloartritis; Guidelines; Guías; Inflammatory back pain; Primary care; Recomendaciones; Recommendations; Referral; Spondyloarthritis