ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2021
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 2433

Evaluation Of The Two-Step Referral Strategy For Axial Spondyloarthritis In The Spondyloarthritis Caught Early Cohort

Ozair Abawi1, Rosaline van den Berg1, Désirée van der Heijde2, Manouk de Hooge1, Pauline Bakker1, Monique Reijnierse3, Tom Huizinga1, Jürgen Braun4 and Floris van Gaalen1, 1Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 2Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, 3Radiology, Leiden University Medical Center, Leiden, Netherlands, 4Rheumazentrum Ruhrgebiet, Herne, Germany

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: classification criteria and spondylarthritis, Referrals

  • Tweet
  • Email
  • Print
Session Information

Session Title: Spondylarthropathies and Psoriatic Arthritis: Clinical Aspects and Treatment III

Session Type: Abstract Submissions (ACR)

Background/Purpose: Currently, in primary care no satisfactory referral model exists for referral to the rheumatologist of patients with chronic back pain (CBP) with possible axial spondyloarthritis (axSpA). Recently, a non-invasive, inexpensive and easily applicable two-step referral strategy was developed, based on a computer-generated model.1The aim of our study was to validate this two-step referral strategy in the SPondyloArthritis Caught Early (SPACE)-cohort.

Methods: In the first step of the referral strategy, the presence of psoriasis, alternating buttock pain (ABP) and improvement of back pain by exercise (IBPE) were registered. If ≥2 of these anamnestic features are present, the patient is referred to a rheumatologist. In the second step, if ≤1 anamnestic feature is present, HLA-B27 testing is performed; if the result is positive, the patient is also referred. The required data was obtained from the SPACE-cohort, in which patients with CBP (≥3 months, ≤2 years, onset <45 years) were included (n=192). The model was tested in this cohort; the performance of the model was evaluated by calculating sensitivity, specificity and likelihood ratios (LR) using classification by ASAS axSpA criteria as external standard.2 For the patients which were erroneously referred or erroneously not referred, post-test probabilities for axSpA were calculated based on LR products for the presence of SpA features3, with a LR product of ≥78 which equals a probability of ≥80% defined as cut-off value for probable axSpA.

Results: A total of 74/192 patients had axSpA (ASAS), 61 of which would have been referred according to the strategy, yielding a sensitivity of 82.4%. The 13 false negatives are obligatory HLA-B27 negatives, have ≥1 SpA feature and sacroiliitis on imaging, 3/13 (23%) of which on X-ray. The referral strategy would have referred a total of 93/192 patients, yielding a specificity of 72.9%. Out of the false positive patients, 8/32 (25%) would have been referred erroneously due to HLA-B27 positivity in absence of ≥2 SpA features. Half of these 32 patients (n=16; 50%) had a combination of ABP and IPBE, which are features of inflammatory back pain, which itself is not specific for axSpA. Although none of these false positives fulfil the ASAS axSpA criteria, 6/32 (19%) had probable axSpA (probability ≥80%) (table).  

Conclusion: The two-step referral strategy performed well in the SPACE-cohort. These results show the potential of simple referral strategies for the early recognition of axSpA. However, all patients in this study had already been referred to the rheumatologist. Thus, the performance of this model in its target population (i.e. primary care) remains to be addressed in further studies.

References:

(1) Braun A et al. Rheumatology (Oxford), 2013 Apr 4 [Epub] doi: 10.1093/rheumatology/ket115               
(2) Rudwaleit M et al. Ann Rheum Dis, 2009;68:777-783
(3) Rudwaleit M et al. Ann Rheum Dis, 2004;63:535–543

Referred to rheumatologist by referral strategy

axSpA by ASAS criteria

Yes

No

Yes

61

32

No

13

86

Sensitivity: 82.4%

Specificity: 72.9%

LR+: 3.04

LR-: 0.24

 

Post-test probability for axSpA

Number of anamnestic features present in false positive patients (n=32)

0-20%

n (%)

20-50%

n (%)

50-80%

n (%)

≥80% (probable axSpA) n (%)

3: ABP, IBPE and psoriasis
    (n=2)

1 (3)

0 (0)

0 (0)

1 (3)

2: ABP and IBPE (n=16)   
    Psoriasis and IBPE (n=5)  
    ABP and psoriasis (n=1)

8 (25)
2 (6)
1 (3)

3 (9)
2 (6)
0 (0)

3 (9)
0 (0)
0 (0)

2 (6)
1 (3)
0 (0)

1*: ABP (n=2)
      IBPE (n=3)
      Psoriasis (n=0)

0 (0)
0 (0)
n/a

0 (0)
0 (0)
n/a

0 (0)
3 (9)
n/a

2 (6)
0 (0)
n/a

0* (n=3)

0 (0)

1 (3)

2 (6)

0 (0)

 

Post-test probability for axSpA

Number of anamnestic features present in false negative patients (n=13)

0-20%

n (%)

20-50%

n (%)

50-80%

n (%)

≥80% (probable axSpA) n (%)

1: ABP (n=2)
    IBPE (n=7)
    Psoriasis (n=2)

0 (0)
3 (23)
0 (0)

1 (8)
2 (15)
1 (8)

0 (0)
0 (0)
1 (8)

1 (8)
2 (15)
0 (0)

0 (n=2)

0 (0)

0 (0)

0 (0)

2 (15)

Anamnestic features: ABP=alternating buttock pain; IBPE=improvement of back pain by exercise; psoriasis.
*: These patients are referred due to HLA-B27 positivity, not anamnestic features.


Disclosure:

O. Abawi,
None;

R. van den Berg,
None;

D. van der Heijde,
None;

M. de Hooge,
None;

P. Bakker,
None;

M. Reijnierse,
None;

T. Huizinga,
None;

J. Braun,
None;

F. van Gaalen,
None.

  • Tweet
  • Email
  • Print

« Back to 2013 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-the-two-step-referral-strategy-for-axial-spondyloarthritis-in-the-spondyloarthritis-caught-early-cohort/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts during your browser session by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2022 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies