Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ..
OBJECTIVES: To investigate the prevalence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP) of less than 2 years (2y) duration referred to the rheumatologist, the development of diagnosis over time, and patient characteristics of those developing definite (d-)axSpA over 2y.
METHODS: We analysed the 2y data from SPondyloArthritis Caught Early, a European cohort of patients (<45 years) with CBP (≥3 months, ≤2y) of unknown origin. The diagnostic workup comprised evaluation of clinical SpA features, acute phase reactants, HLA-B27, radiographs and MRI (sacroiliac joints and spine), with repeated assessments. At each visit (baseline, 3 months, 1y and 2y), rheumatologists reported a diagnosis of axSpA or non-axSpA with level of confidence (LoC; 0-not confident at all to 10-very confident).
MAIN OUTCOME: axSpA diagnosis with LoC≥7 (d-axSpA) at 2y.
RESULTS: In 552 patients with CBP, d-axSpA was diagnosed in 175 (32%) at baseline and 165 (30%) at 2y. Baseline diagnosis remained rather stable: at 2y, baseline d-axSpA was revised in 5% of patients, while 8% 'gained' d-axSpA. Diagnostic uncertainty persisted in 30%. HLA-B27+ and baseline sacroiliitis imaging discriminated best 2y-d-axSpA versus 2y-d-non-axSpA patients. Good response to non-steroidal anti-inflammatory drugs and MRI-sacroiliitis most frequently developed over follow-up in patients with a new d-axSpA diagnosis. Of the patients who developed MRI-sacroiliitis, 7/8 were HLA-B27+ and 5/8 male.
CONCLUSION: A diagnosis of d-axSpA can be reliably made in nearly one-third of patients with CBP referred to the rheumatologist, but diagnostic uncertainty may persist in 5%-30% after 2y. Repeated assessments yield is modest, but repeating MRI may be worthwhile in male HLA-B27+ patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:83 |
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| Enthalten in: |
Annals of the rheumatic diseases - 83(2024), 5 vom: 11. Apr., Seite 589-598 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Marques, Mary Lucy [VerfasserIn] |
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| Links: |
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Classification |
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| Anmerkungen: |
Date Completed 15.04.2024 Date Revised 15.04.2024 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/ard-2023-224959 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367236168 |
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| 100 | 1 | |a Marques, Mary Lucy |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Can rheumatologists unequivocally diagnose axial spondyloarthritis in patients with chronic back pain of less than 2 years duration? Primary outcome of the 2-year SPondyloArthritis Caught Early (SPACE) cohort |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 15.04.2024 | ||
| 500 | |a Date Revised 15.04.2024 | ||
| 500 | |a published: Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a OBJECTIVES: To investigate the prevalence of axial spondyloarthritis (axSpA) in patients with chronic back pain (CBP) of less than 2 years (2y) duration referred to the rheumatologist, the development of diagnosis over time, and patient characteristics of those developing definite (d-)axSpA over 2y | ||
| 520 | |a METHODS: We analysed the 2y data from SPondyloArthritis Caught Early, a European cohort of patients (<45 years) with CBP (≥3 months, ≤2y) of unknown origin. The diagnostic workup comprised evaluation of clinical SpA features, acute phase reactants, HLA-B27, radiographs and MRI (sacroiliac joints and spine), with repeated assessments. At each visit (baseline, 3 months, 1y and 2y), rheumatologists reported a diagnosis of axSpA or non-axSpA with level of confidence (LoC; 0-not confident at all to 10-very confident) | ||
| 520 | |a MAIN OUTCOME: axSpA diagnosis with LoC≥7 (d-axSpA) at 2y | ||
| 520 | |a RESULTS: In 552 patients with CBP, d-axSpA was diagnosed in 175 (32%) at baseline and 165 (30%) at 2y. Baseline diagnosis remained rather stable: at 2y, baseline d-axSpA was revised in 5% of patients, while 8% 'gained' d-axSpA. Diagnostic uncertainty persisted in 30%. HLA-B27+ and baseline sacroiliitis imaging discriminated best 2y-d-axSpA versus 2y-d-non-axSpA patients. Good response to non-steroidal anti-inflammatory drugs and MRI-sacroiliitis most frequently developed over follow-up in patients with a new d-axSpA diagnosis. Of the patients who developed MRI-sacroiliitis, 7/8 were HLA-B27+ and 5/8 male | ||
| 520 | |a CONCLUSION: A diagnosis of d-axSpA can be reliably made in nearly one-third of patients with CBP referred to the rheumatologist, but diagnostic uncertainty may persist in 5%-30% after 2y. Repeated assessments yield is modest, but repeating MRI may be worthwhile in male HLA-B27+ patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Classification | |
| 650 | 4 | |a Outcome and Process Assessment, Health Care | |
| 650 | 4 | |a Spondylitis, Ankylosing | |
| 650 | 7 | |a HLA-B27 Antigen |2 NLM | |
| 700 | 1 | |a Ramiro, Sofia |e verfasserin |4 aut | |
| 700 | 1 | |a van Lunteren, Miranda |e verfasserin |4 aut | |
| 700 | 1 | |a Stal, Rosalinde Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Landewé, Robert Bm |e verfasserin |4 aut | |
| 700 | 1 | |a van de Sande, Marleen |e verfasserin |4 aut | |
| 700 | 1 | |a Fagerli, Karen Minde |e verfasserin |4 aut | |
| 700 | 1 | |a Berg, Inger Jorid |e verfasserin |4 aut | |
| 700 | 1 | |a van Oosterhout, Maikel |e verfasserin |4 aut | |
| 700 | 1 | |a Exarchou, Sofia |e verfasserin |4 aut | |
| 700 | 1 | |a Ramonda, Roberta |e verfasserin |4 aut | |
| 700 | 1 | |a van der Heijde, Désirée |e verfasserin |4 aut | |
| 700 | 1 | |a van Gaalen, Floris A |e verfasserin |4 aut | |
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