Background/Purpose There is a substantial gap of 5 to 8 years between the onset of symptoms (usually back pain) and the diagnosis of axial spondyloarthritis (SpA). One of the reasons for such a delay is a late referral of patients to a rheumatologist by general practitioners and other physicians encountering patients with back pain. Several referral approaches have been proposed and tested over the last 10 years, however, no universal and widely accepted referral strategy exists until now. The aim was, therefore, to develop consensual recommendations under the umbrella of the Assessment of Spondyloarthritis international Society (ASAS) for early referral of patients suspected for axial SpA by primary care physicians or non-rheumatology specialists.

Methods Development of the ASAS endorsed referral recommendations for  patients suspected for axial SpA by primary care physicians or non-rheumatology specialists consisted of the following phases: 1) systematic literature review, 2) the first Delphi round aimed at identification of unmet needs and development of the referral parameter candidate list, 3) the second Delphi round aimed at identification of the most useful combination of the referral parameters, 4) final discussion on the proposal for the recommendations and voting on it at ASAS annual meeting in 2014. 

Results

The following consensus on the referral recommendation was achieved within ASAS as a result of the Delphi process and final voting.

“Patients with chronic back pain (duration ≥3 months) and back pain onset before 45 years of age should be referred to a rheumatologist if at least one of the following parameters is present: 

•  Inflammatory back pain;
•  HLA-B27 positivity;
•  Sacroiliitis on imaging if available (X-rays or magnetic resonance imaging);
•  Peripheral manifestations (arthritis, enthesitis, dactylitis);
•  Extra-articular manifestations (psoriasis, inflammatory bowel disease, uveitis);
•  Positive family history for SpA;
•  Good response to non-steroidal anti-inflammatory drugs;
•  Elevated acute phase reactants.”

Conclusion A consensual ASAS endorsed referral recommendation for patients suspected for axial SpA by primary care physicians or non-rheumatology specialists was developed as a flexible and universal tool to be used in clinical practice. The diagnostic value of this tool applied in different settings should be determined in future studies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-spondyloarthritis-international-society-endorsed-recommendations-for-early-referral-of-patients-suspected-for-axial-spondyloarthritis/