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Simple Referral Rule May Lead to Earlier Referral and Diagnosis of Axial Spondyloarthritis

Early referral and diagnosis remains a challenge for many who care for patients with musculoskeletal complaints.  This is especially so in those with chronic low back pain (LBP) and the minority who will have ankylosing spondylitis or axial spondyloarthritis.

As many LBP patients will first seek attention with their primary care physicians, Dutch researchers set out to establish rules for referral of those patients with chronic low back pain (CLBP) suspected to be at risk for axial spondyloarthritis (axSpA).

The referral rule (CaFaSpA referral rule) was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables:

  • inflammatory back pain
  • good response to nonsteriodal anti-inflammatory drugs
  • family history of spondyloarthritis
  • back pain duration longer than five years

This referral rule is positive when at least two variables are present.

Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients. Using this rule, they found that 16% (n=95) of CLBP patients had axial spondyloarthritis. The sensitivity was 75% and specificity was 58%.  

The positive predictive value of the CaFaSpA referral rule was 30.2%. Given that roughly 5% of patients with CLBP will have axial spondyloarthritis, the use of the referral rule would significantly enhance the appropriate referral of those patients suspected of having axial spondyloarthritis.

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Disclosures
The author has no conflicts of interest to disclose related to this subject