Braun, Annalina and Gnann, Holger and Saracbasi, Ertan and Grifka, Joachim and Kiltz, Uta and Letschert, Katrin and Braun, Juergen (2013) 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, 52 (8). pp. 1418-1424. ISSN 1462-0324,
Full text not available from this repository. (Request a copy)Abstract
Methods. 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. Results. 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 (sensitivity 80.4%, specificity 75.4%, LR+ 3.27 and LR- 0.26). Conclusion. This is the first study to show that patients with axSpA are more reliably identified in primary care by a strategy that includes HLA B27. Because of the two-step approach, the test needs to be performed in only about half of patients with chronic BP.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | INFLAMMATORY BACK-PAIN; SOCIETY CLASSIFICATION CRITERIA; ANKYLOSING-SPONDYLITIS; REFERRAL RECOMMENDATIONS; DIAGNOSTIC-CRITERIA; POSITIVE PATIENTS; HLA-B27; SPONDYLARTHRITIS; DISEASE; COHORT; axial spondyloarthritis; ankylosing spondylitis; inflammatory back pain; HLA B27; primary care |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Orthopädie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 06 Apr 2020 11:36 |
| Last Modified: | 06 Apr 2020 11:36 |
| URI: | https://pred.uni-regensburg.de/id/eprint/16339 |
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