Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay
Atul Deodhar,Manish Mittal,Patrick Reilly,Yanjun Bao,Shivaji Manthena,Jaclyn K Anderson,Avani Joshi +6 more
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TLDR
This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals.Abstract:
This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18-64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000-December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR] = 0.986; p < 0.0001), male (HR = 1.15; p = 0.0163), diagnosed with uveitis (HR = 1.49; p = 0.0050), referred by primary care physicians (HR = 1.96; p < 0.0001), prescribed non-steroidal anti-inflammatory drugs (HR = 1.55; p < 0.0001), disease-modifying antirheumatic drugs (HR = 1.33; p < 0.0001), and tumor necrosis factor inhibitors (HR = 1.40; p = 0.0036), and to have had spinal/pelvic X-ray prior to referral (HR = 1.28; p = 0.0003). During 2000-2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.read more
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References
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TL;DR: This guideline is to present the available evidence for evaluation and management of acute and chronic low back pain in primary care settings and grades its recommendations by using the ACP's clinical practice guidelines grading system.
Journal ArticleDOI
The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis
Joachim Sieper,M. Rudwaleit,Xenofon Baraliakos,J Brandt,Jürgen Braun,Ruben Burgos-Vargas,Maxime Dougados,K.-G. Hermann,Robert Landewé,Walter P. Maksymowych,D. van der Heijde +10 more
TL;DR: A comprehensive handbook on the most relevant aspects for the assessments of spondyloarthritis, covering classification criteria, MRI and x rays for sacroiliac joints and the spine, a complete set of all measurements relevant for clinical trials and international recommendations for the management of SpA are provided.
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2010 update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis
Jürgen Braun,R. van den Berg,Xenofon Baraliakos,H. Boehm,Ruben Burgos-Vargas,Eduardo Collantes-Estevez,B. Dijkmans,Paul Emery,Muhammad Asim Khan,Karel Pavelka +9 more
TL;DR: The ASAS/EULAR recommendations on the management of ankylo sing spondylitis (AS) are based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010 as mentioned in this paper.
2010 Update of the ASAS/EULAR recommendations for the management of ankylosing spondylitis
Jürgen Braun,R. van den Berg,Xenofon Baraliakos,H. Boehm,Ruben Burgos-Vargas,Eduardo Collantes-Estevez,Hanne Dagfinrud,B. Dijkmans,Maxime Dougados,Paul Emery,P. Geher,Mohammed Hammoudeh,Robert D. Inman,Merryn Jongkees,Muhammad Asim Khan,Uta Kiltz,Tore K Kvien,Marjatta Leirisalo-Repo,Walter P. Maksymowych,I. Olivieri,Karel Pavelka,Joachim Sieper,Ewa Stanislawska-Biernat,D. Wendling,Salih Ozgocmen,C. Van Drogen,B.J. van Royen,D. van der Heijde +27 more
TL;DR: This first update of the ASAS/EULAR recommendations on the management of ankylosing spondylitis is based on the original paper, a systematic review of existing recommendations and the literature since 2005 and the discussion and agreement among 21 international experts, 2 patients and 2 physiotherapists in a meeting in February 2010.
Journal ArticleDOI
Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis
Ernst Feldtkeller,Muhammad Asim Khan,Désirée van der Heijde,Sjef van der Linden,Jürgen Braun +4 more
TL;DR: This study of a much larger number of B27– AS patients than have been studied previously confirms earlier reports indicating a significantly older average age at disease onset and a less frequent prevalence of acute anterior uveitis in B 27– than in B27+ AS.
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