Skip to main content

Rheumatologists and the Early Diagnosis of Spondyloarthritis

SPACE study of adults referred to rheumatology with less than 2 years of chronic back pain (CBP), shows that only one-third can be reliably diagnosed with axial spondyloarthritis (axSpA).

Data from SPondyloArthritis Caught Early European cohort of early CBP patients (<45 years; Sxs ≥3 months, ≤2y) of unknown origin. Such patients were repeatedly evaluated clinically, radiographically (radiographs and MRI) along with serologies and HLA-B27. The main outcome was the diagnosis of axSpA diagnosis at 2yrs.

The total included 552 patients with CBP, from which 175 (32%) were diagnosed with axSpA at baseline and another 165 (30%) at 2yrs.  From baseline, the axSpA diagnosis was revised in 5% of patients. Overall, diagnostic uncertainty persisted in 30%.

Best predictors of a 2 year diagnosis axSpA was HLA-B27+ and baseline sacroiliitis imaging.

Over 2 years 8 patients developed MRI-sacroiliitis; 7/8 were HLA-B27+ and 5/8 male.

The diagnosis of axSpA can be reliably made in nearly one-third of patients with CBP upon presentation to the rheumatologist; and with time another 5%–30% may evolve into axSpA by 2y.  The value of repeat MRI of the SI is modest but may be worthwhile in male HLA-B27+ patients.


If you are a health practitioner, you may to comment.

Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.

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