AB0736 Strategy for the Early Detection and Referral of Patients with Suspected Spondyloarthritis
Objectives To design a strategy for early detection and referral of patients with suspected spondyloarthritis (SpA) by primary care physicians (PCP). Methods We used a modified RAND/UCLA methodology and systematic review (SR). A discussion group, formed by rheumatologists and PCP, discussed the proc...
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| Veröffentlicht in: | Annals of the rheumatic diseases 2014-06, Vol.73 (Suppl 2), p.1046 |
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| creator | Juanola, X. Collantes, E. Leόn, F. Torres, A. García de Yébenes, M.J. Queiro, R. Gratacόs, J. García Criado, E. Giménez, S. Carmona, L. |
| description | Objectives To design a strategy for early detection and referral of patients with suspected spondyloarthritis (SpA) by primary care physicians (PCP). Methods We used a modified RAND/UCLA methodology and systematic review (SR). A discussion group, formed by rheumatologists and PCP, discussed the process map and proposed recommendations and algorithms. These, together with the results of the SR, underwent 2 Delphi rounds to assess acceptance by a large group of users. Results The recommendations and grade of agreement are presnted in Table 1). Table 1 Recommendation Mean agreement/10 As an entry criterion, we should investigate the presence of inflammatory back pain (IBP) in patients |
| doi_str_mv | 10.1136/annrheumdis-2014-eular.1812 |
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| fullrecord | <record><control><sourceid>proquest_bmj_p</sourceid><recordid>TN_cdi_proquest_journals_1777975704</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>4008699871</sourcerecordid><originalsourceid>FETCH-LOGICAL-b754-396a81faf8b5677f011f95319629ec9536808496ceca404fd80433471df153f53</originalsourceid><addsrcrecordid>eNpNkE1OwzAQhS0EEqVwB0tdp3hqx3aWpZSCVAlEu7fcxCapUifYjlB2bLgoJyGlLFjNj96bp_kQmgCZAlB-q53zpekORRWSGQGWmK7WfgoSZmdoBIzLYc3JORoRQmjCMi4u0VUI-2EkEuQI5fM7Iij__vzaRK-jeeuxbTyOpcFL7ese35to8lg1DmtX4Fdjjfe6xo3FLzpWxsWAP6pY4k0X2kFoCrxpG1f0daN9LH0Vq3CNLqyug7n5q2O0fVhuF4_J-nn1tJivk51IWUIzriVYbeUu5UJYAmCzlELGZ5nJh45LIocPcpNrRpgtJGGUMgGFhZTalI7R5HS29c17Z0JU-6bzbkhUIITIRCoGxxjxk2p32KvWVwftewVEHXmqfzzVkaf65amOPOkPc1xu2Q</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1777975704</pqid></control><display><type>article</type><title>AB0736 Strategy for the Early Detection and Referral of Patients with Suspected Spondyloarthritis</title><source>BMJ Journals - NESLi2</source><creator>Juanola, X. ; Collantes, E. ; Leόn, F. ; Torres, A. ; García de Yébenes, M.J. ; Queiro, R. ; Gratacόs, J. ; García Criado, E. ; Giménez, S. ; Carmona, L.</creator><creatorcontrib>Juanola, X. ; Collantes, E. ; Leόn, F. ; Torres, A. ; García de Yébenes, M.J. ; Queiro, R. ; Gratacόs, J. ; García Criado, E. ; Giménez, S. ; Carmona, L.</creatorcontrib><description>Objectives To design a strategy for early detection and referral of patients with suspected spondyloarthritis (SpA) by primary care physicians (PCP). Methods We used a modified RAND/UCLA methodology and systematic review (SR). A discussion group, formed by rheumatologists and PCP, discussed the process map and proposed recommendations and algorithms. These, together with the results of the SR, underwent 2 Delphi rounds to assess acceptance by a large group of users. Results The recommendations and grade of agreement are presnted in Table 1). Table 1 Recommendation Mean agreement/10 As an entry criterion, we should investigate the presence of inflammatory back pain (IBP) in patients <45 years (1) who attend for chronic back pain as main consultation reason (2); if pain lasts ≥3 months (3) and is perceived by the patient as continuous, while recognizing fluctuations (4). (1) 8.6(2) 7.6(3) 8.3(4) 7.4 It is recommended to investigate these patients in 4 phases 1) key questions, 2) additional questions, 3) physical examination, and 4) additional tests. 8.4 Refer the patient to rheumatology if1) mainly night pain, defined as pain that wakes the patient, especially in the second part of the night and forces the patient to get up (1),2) pain improves with physical activity and worsens with rest (2). (1) 8.8(2) 8.0 If the answer to the above questions is negative but suspicion remains, then inquire about the following. If any is positive, refer the patient to rheumatology.– alternating buttock pain/sciatica (1)– gradual onset (2)– pain responds to full–dose NSAIDs, but not to analgesics, and reappears when NSAIDs are stopped (3)– heel pain (4)– arthritis in lower limbs (5)– psoriasis (6), or uveitis (7), or inflammatory bowel disease [IBD] (8)– or family history of psoriasis (10), IBD (11), or ankylosing spondylitis (12). (1) 7.7(2) 7.0(3) 8.0(4) 7.0(5) 8.0(6) 7.9(7) 8.6(8) 8.1(10) 6.8(11) 6.6(12) 7.4 If all is negative, and doubt remains, consider a physical examination to confirm arthritis or dactylitis. 8.3 The only additional tests that could guide and should be performed by PCP, depending on availability, are– PA sacroiliac X–ray (1),– lab tests: ESR (2), PCR (3) and HLAB27 (4). (1) 8.4(2) 7.5(3) 7.9(4) 8.3 In areas where access to tests or to their results is limited, doubtful cases should be referred to a rheumatologist without ordering the tests. 7.9 The rheumatology reference service should design feedback strategies to improve referrals. 8.3 To improve the speed of referral, the panel recommends:– to maintain rheumatology waiting lists below reasonable limits (<1 mo.) (1), or– to establish of early SpA units (2). or– to agree on fast tracks in the area (3) (1) 8.7(2) 8.8(3) 8.3 Conclusions Any chronic (>3 months) LBP in <45 years patients should be investigated in 4 phases 1) key questions, 2) extra questions, 3) physical examination, and 4) additional tests. They should be referred to rheumatology if having 1) IBP, 2) signs suggestive of SpA, or 3) HLA B27+, elevated CRP, or sacroiliitis. Recommendations on the referral process are included. Acknowledgements This project was supported by a grant from MSD. Disclosure of Interest X. Juanola: None declared, E. Collantes: None declared, F. Leόn: None declared, A. Torres: None declared, M. J. García de Yébenes: None declared, R. Queiro: None declared, J. Gratacόs: None declared, E. García Criado: None declared, S. Giménez: None declared, L. Carmona Grant/research support: Abbvie, MSD, Roche, Speakers bureau: Roche, Pfizer DOI 10.1136/annrheumdis-2014-eular.1812</description><identifier>ISSN: 0003-4967</identifier><identifier>EISSN: 1468-2060</identifier><identifier>DOI: 10.1136/annrheumdis-2014-eular.1812</identifier><identifier>CODEN: ARDIAO</identifier><language>eng</language><publisher>London: BMJ Publishing Group LTD</publisher><ispartof>Annals of the rheumatic diseases, 2014-06, Vol.73 (Suppl 2), p.1046</ispartof><rights>2014, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><rights>Copyright: 2014 (c) 2014, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttp://ard.bmj.com/content/73/Suppl_2/1046.3.full.pdf$$EPDF$$P50$$Gbmj$$H</linktopdf><linktohtml>$$Uhttp://ard.bmj.com/content/73/Suppl_2/1046.3.full$$EHTML$$P50$$Gbmj$$H</linktohtml><link.rule.ids>114,115,314,780,784,23571,27924,27925,77600,77631</link.rule.ids></links><search><creatorcontrib>Juanola, X.</creatorcontrib><creatorcontrib>Collantes, E.</creatorcontrib><creatorcontrib>Leόn, F.</creatorcontrib><creatorcontrib>Torres, A.</creatorcontrib><creatorcontrib>García de Yébenes, M.J.</creatorcontrib><creatorcontrib>Queiro, R.</creatorcontrib><creatorcontrib>Gratacόs, J.</creatorcontrib><creatorcontrib>García Criado, E.</creatorcontrib><creatorcontrib>Giménez, S.</creatorcontrib><creatorcontrib>Carmona, L.</creatorcontrib><title>AB0736 Strategy for the Early Detection and Referral of Patients with Suspected Spondyloarthritis</title><title>Annals of the rheumatic diseases</title><description>Objectives To design a strategy for early detection and referral of patients with suspected spondyloarthritis (SpA) by primary care physicians (PCP). Methods We used a modified RAND/UCLA methodology and systematic review (SR). A discussion group, formed by rheumatologists and PCP, discussed the process map and proposed recommendations and algorithms. These, together with the results of the SR, underwent 2 Delphi rounds to assess acceptance by a large group of users. Results The recommendations and grade of agreement are presnted in Table 1). Table 1 Recommendation Mean agreement/10 As an entry criterion, we should investigate the presence of inflammatory back pain (IBP) in patients <45 years (1) who attend for chronic back pain as main consultation reason (2); if pain lasts ≥3 months (3) and is perceived by the patient as continuous, while recognizing fluctuations (4). (1) 8.6(2) 7.6(3) 8.3(4) 7.4 It is recommended to investigate these patients in 4 phases 1) key questions, 2) additional questions, 3) physical examination, and 4) additional tests. 8.4 Refer the patient to rheumatology if1) mainly night pain, defined as pain that wakes the patient, especially in the second part of the night and forces the patient to get up (1),2) pain improves with physical activity and worsens with rest (2). (1) 8.8(2) 8.0 If the answer to the above questions is negative but suspicion remains, then inquire about the following. If any is positive, refer the patient to rheumatology.– alternating buttock pain/sciatica (1)– gradual onset (2)– pain responds to full–dose NSAIDs, but not to analgesics, and reappears when NSAIDs are stopped (3)– heel pain (4)– arthritis in lower limbs (5)– psoriasis (6), or uveitis (7), or inflammatory bowel disease [IBD] (8)– or family history of psoriasis (10), IBD (11), or ankylosing spondylitis (12). (1) 7.7(2) 7.0(3) 8.0(4) 7.0(5) 8.0(6) 7.9(7) 8.6(8) 8.1(10) 6.8(11) 6.6(12) 7.4 If all is negative, and doubt remains, consider a physical examination to confirm arthritis or dactylitis. 8.3 The only additional tests that could guide and should be performed by PCP, depending on availability, are– PA sacroiliac X–ray (1),– lab tests: ESR (2), PCR (3) and HLAB27 (4). (1) 8.4(2) 7.5(3) 7.9(4) 8.3 In areas where access to tests or to their results is limited, doubtful cases should be referred to a rheumatologist without ordering the tests. 7.9 The rheumatology reference service should design feedback strategies to improve referrals. 8.3 To improve the speed of referral, the panel recommends:– to maintain rheumatology waiting lists below reasonable limits (<1 mo.) (1), or– to establish of early SpA units (2). or– to agree on fast tracks in the area (3) (1) 8.7(2) 8.8(3) 8.3 Conclusions Any chronic (>3 months) LBP in <45 years patients should be investigated in 4 phases 1) key questions, 2) extra questions, 3) physical examination, and 4) additional tests. They should be referred to rheumatology if having 1) IBP, 2) signs suggestive of SpA, or 3) HLA B27+, elevated CRP, or sacroiliitis. Recommendations on the referral process are included. Acknowledgements This project was supported by a grant from MSD. Disclosure of Interest X. Juanola: None declared, E. Collantes: None declared, F. Leόn: None declared, A. Torres: None declared, M. J. García de Yébenes: None declared, R. Queiro: None declared, J. Gratacόs: None declared, E. García Criado: None declared, S. Giménez: None declared, L. Carmona Grant/research support: Abbvie, MSD, Roche, Speakers bureau: Roche, Pfizer DOI 10.1136/annrheumdis-2014-eular.1812</description><issn>0003-4967</issn><issn>1468-2060</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNpNkE1OwzAQhS0EEqVwB0tdp3hqx3aWpZSCVAlEu7fcxCapUifYjlB2bLgoJyGlLFjNj96bp_kQmgCZAlB-q53zpekORRWSGQGWmK7WfgoSZmdoBIzLYc3JORoRQmjCMi4u0VUI-2EkEuQI5fM7Iij__vzaRK-jeeuxbTyOpcFL7ese35to8lg1DmtX4Fdjjfe6xo3FLzpWxsWAP6pY4k0X2kFoCrxpG1f0daN9LH0Vq3CNLqyug7n5q2O0fVhuF4_J-nn1tJivk51IWUIzriVYbeUu5UJYAmCzlELGZ5nJh45LIocPcpNrRpgtJGGUMgGFhZTalI7R5HS29c17Z0JU-6bzbkhUIITIRCoGxxjxk2p32KvWVwftewVEHXmqfzzVkaf65amOPOkPc1xu2Q</recordid><startdate>201406</startdate><enddate>201406</enddate><creator>Juanola, X.</creator><creator>Collantes, E.</creator><creator>Leόn, F.</creator><creator>Torres, A.</creator><creator>García de Yébenes, M.J.</creator><creator>Queiro, R.</creator><creator>Gratacόs, J.</creator><creator>García Criado, E.</creator><creator>Giménez, S.</creator><creator>Carmona, L.</creator><general>BMJ Publishing Group LTD</general><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88I</scope><scope>8AF</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9-</scope><scope>K9.</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2P</scope><scope>M7P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope></search><sort><creationdate>201406</creationdate><title>AB0736 Strategy for the Early Detection and Referral of Patients with Suspected Spondyloarthritis</title><author>Juanola, X. ; Collantes, E. ; Leόn, F. ; Torres, A. ; García de Yébenes, M.J. ; Queiro, R. ; Gratacόs, J. ; García Criado, E. ; Giménez, S. ; Carmona, L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b754-396a81faf8b5677f011f95319629ec9536808496ceca404fd80433471df153f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Juanola, X.</creatorcontrib><creatorcontrib>Collantes, E.</creatorcontrib><creatorcontrib>Leόn, F.</creatorcontrib><creatorcontrib>Torres, A.</creatorcontrib><creatorcontrib>García de Yébenes, M.J.</creatorcontrib><creatorcontrib>Queiro, R.</creatorcontrib><creatorcontrib>Gratacόs, J.</creatorcontrib><creatorcontrib>García Criado, E.</creatorcontrib><creatorcontrib>Giménez, S.</creatorcontrib><creatorcontrib>Carmona, L.</creatorcontrib><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Science Database</collection><collection>Biological Science Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><jtitle>Annals of the rheumatic diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Juanola, X.</au><au>Collantes, E.</au><au>Leόn, F.</au><au>Torres, A.</au><au>García de Yébenes, M.J.</au><au>Queiro, R.</au><au>Gratacόs, J.</au><au>García Criado, E.</au><au>Giménez, S.</au><au>Carmona, L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>AB0736 Strategy for the Early Detection and Referral of Patients with Suspected Spondyloarthritis</atitle><jtitle>Annals of the rheumatic diseases</jtitle><date>2014-06</date><risdate>2014</risdate><volume>73</volume><issue>Suppl 2</issue><spage>1046</spage><pages>1046-</pages><issn>0003-4967</issn><eissn>1468-2060</eissn><coden>ARDIAO</coden><abstract>Objectives To design a strategy for early detection and referral of patients with suspected spondyloarthritis (SpA) by primary care physicians (PCP). Methods We used a modified RAND/UCLA methodology and systematic review (SR). A discussion group, formed by rheumatologists and PCP, discussed the process map and proposed recommendations and algorithms. These, together with the results of the SR, underwent 2 Delphi rounds to assess acceptance by a large group of users. Results The recommendations and grade of agreement are presnted in Table 1). Table 1 Recommendation Mean agreement/10 As an entry criterion, we should investigate the presence of inflammatory back pain (IBP) in patients <45 years (1) who attend for chronic back pain as main consultation reason (2); if pain lasts ≥3 months (3) and is perceived by the patient as continuous, while recognizing fluctuations (4). (1) 8.6(2) 7.6(3) 8.3(4) 7.4 It is recommended to investigate these patients in 4 phases 1) key questions, 2) additional questions, 3) physical examination, and 4) additional tests. 8.4 Refer the patient to rheumatology if1) mainly night pain, defined as pain that wakes the patient, especially in the second part of the night and forces the patient to get up (1),2) pain improves with physical activity and worsens with rest (2). (1) 8.8(2) 8.0 If the answer to the above questions is negative but suspicion remains, then inquire about the following. If any is positive, refer the patient to rheumatology.– alternating buttock pain/sciatica (1)– gradual onset (2)– pain responds to full–dose NSAIDs, but not to analgesics, and reappears when NSAIDs are stopped (3)– heel pain (4)– arthritis in lower limbs (5)– psoriasis (6), or uveitis (7), or inflammatory bowel disease [IBD] (8)– or family history of psoriasis (10), IBD (11), or ankylosing spondylitis (12). (1) 7.7(2) 7.0(3) 8.0(4) 7.0(5) 8.0(6) 7.9(7) 8.6(8) 8.1(10) 6.8(11) 6.6(12) 7.4 If all is negative, and doubt remains, consider a physical examination to confirm arthritis or dactylitis. 8.3 The only additional tests that could guide and should be performed by PCP, depending on availability, are– PA sacroiliac X–ray (1),– lab tests: ESR (2), PCR (3) and HLAB27 (4). (1) 8.4(2) 7.5(3) 7.9(4) 8.3 In areas where access to tests or to their results is limited, doubtful cases should be referred to a rheumatologist without ordering the tests. 7.9 The rheumatology reference service should design feedback strategies to improve referrals. 8.3 To improve the speed of referral, the panel recommends:– to maintain rheumatology waiting lists below reasonable limits (<1 mo.) (1), or– to establish of early SpA units (2). or– to agree on fast tracks in the area (3) (1) 8.7(2) 8.8(3) 8.3 Conclusions Any chronic (>3 months) LBP in <45 years patients should be investigated in 4 phases 1) key questions, 2) extra questions, 3) physical examination, and 4) additional tests. They should be referred to rheumatology if having 1) IBP, 2) signs suggestive of SpA, or 3) HLA B27+, elevated CRP, or sacroiliitis. Recommendations on the referral process are included. Acknowledgements This project was supported by a grant from MSD. Disclosure of Interest X. Juanola: None declared, E. Collantes: None declared, F. Leόn: None declared, A. Torres: None declared, M. J. García de Yébenes: None declared, R. Queiro: None declared, J. Gratacόs: None declared, E. García Criado: None declared, S. Giménez: None declared, L. Carmona Grant/research support: Abbvie, MSD, Roche, Speakers bureau: Roche, Pfizer DOI 10.1136/annrheumdis-2014-eular.1812</abstract><cop>London</cop><pub>BMJ Publishing Group LTD</pub><doi>10.1136/annrheumdis-2014-eular.1812</doi></addata></record> |
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| title | AB0736 Strategy for the Early Detection and Referral of Patients with Suspected Spondyloarthritis |
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