Optimizing the identification of patients with axial spondyloarthritis in primary care--the case for a two-step strategy combining the most relevant clinical items with HLA B27

Rheumatology
Annalina BraunJ Braun

Abstract

The combination of clinical items suggestive of inflammatory back pain has proved useful for early identification of patients with axial SpA (axSpA) in primary care. However, whether HLA B27 contributes to that is unclear, and published recommendations have advised against it. In this study, we reanalysed data of that trial in relation to the HLA B27 results. Consecutive patients <45 years old (n = 950) with back pain (BP) >2 months presenting to 143 orthopaedists were referred to 36 rheumatologists who made the diagnosis. The predictive value of HLA B27 (n = 298) alone and in combination, including modelling and a two-step strategy, was calculated. Among all patients (mean age 36 years, 52% female, median duration of BP 32 months), 107 had axSpA (36%). Using a simple model, HLA B27 alone performed better than all combinations of clinical items and adding it did not improve likelihood ratios (LRs). Using modelling, two-phase strategies were analysed. Additional items were only relevant in the HLA B27-negative group: improvement by movement, buttock pain and psoriasis. Combining this information revealed the presumably best strategy to predict axSpA in primary care: more than one of these items or HLA B27 need to be present (sen...Continue Reading

References

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May 5, 2011·Annals of the Rheumatic Diseases·Désirée van der HeijdeUNKNOWN Assessment of SpondyloArthritis international Society

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Citations

Mar 29, 2014·International Journal of Rheumatic Diseases·Philip C RobinsonMatthew A Brown
May 21, 2015·Annals of the Rheumatic Diseases·Denis PoddubnyyUNKNOWN Assessment of SpondyloArthritis international Society (ASAS)
Jan 1, 2015·Nature Reviews. Disease Primers·Joachim SieperDominique Baeten
Jun 23, 2015·Best Practice & Research. Clinical Rheumatology·J BraunU Kiltz
Mar 26, 2015·Zeitschrift für Rheumatologie·J Sieper, J Braun
Jan 27, 2017·Zeitschrift für Rheumatologie·X BaraliakosJ Braun
Jan 27, 2016·The Journal of International Medical Research·Mohammed HammoudehUppal Sukhbir
Oct 14, 2017·Rheumatology·Chong Seng Edwin LimKarl Gaffney
Jul 1, 2016·Genetics in Medicine : Official Journal of the American College of Medical Genetics·Maren T ScheunerIra M Lubin
Nov 17, 2014·The Journal of Rheumatology·Jurgen BraunJoachim Sieper
Jan 17, 2019·Rheumatology·Alexandre Rocha SeprianoJaime Branco
Aug 4, 2019·Zeitschrift für Rheumatologie·J BraunU Kiltz
Dec 28, 2018·Clinical Rheumatology·Abhijeet Danve, Atul Deodhar
Apr 22, 2021·Current Opinion in Rheumatology·Denis Poddubnyy, Joachim Sieper
Oct 10, 2021·Clinical Rheumatology·Ling XiangJulian Thumboo

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