Juanola Xavier, Fernández-Sueiro José Luis, Torre-Alonso Juan Carlos, Miguélez Roberto, Muñoz-Fernández Santiago, Ballina Javier, González Carlos, Juliá Berta, Cea-Calvo Luis, Collantes Eduardo
Servicio de Reumatología, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, España.
Reumatol Clin. 2013 Nov-Dec;9(6):348-52. doi: 10.1016/j.reuma.2013.02.009. Epub 2013 Jun 2.
Improving referral of patients with back pain to rheumatologists could accelerate the diagnosis of axial spondyloarthritis. The RADAR study compared two strategies in the referral of patients with chronic back pain (>3 months) with an onset before the age of 45 years from primary care centers to rheumatology departments, in relation to the diagnosis of axial spondyloarthritis.
Each primary care center was assigned a referral strategy for its patients: (a) strategy 1, patients who had one of the 3 following criteria: inflammatory back pain, HLA-B27 positivity or sacroiliitis in imaging; or (b) strategy 2, patients who had 2 of the following 6: inflammatory back pain, HLA-B27 positivity, sacroiliitis in imaging, family history of axial spondyloarthritis, extra-articular manifestations or good response to nonsteroidal antiinflammatory drugs. The rheumatologist established the final diagnosis.
Eighty-eight Spanish patients (mean age 36.8 years [SD 8.7], 55.7% females and 44.3% males) were referred for evaluation, 60 patients under strategy 1 and 28 under strategy 2. A definitive diagnosis of axial spondyloarthritis was established in 25.4% with strategy 1 and in 28.6% with strategy 2 (p=NS). Inflammatory back pain was the criterion most commonly used for referral, and the agreement rate between the primary care physician and rheumatologist was 75%.
A simple referral strategy based on one of three3 criteria proved as effective as a strategy based on two of 6 criteria in diagnosing axial spondyloarthritis. Inflammatory back pain was the criterion most commonly used for patient referral.
改善背痛患者转诊至风湿病专科医生处的情况，可能会加速轴性脊柱关节炎的诊断。RADAR研究比较了两种将45岁之前发病的慢性背痛（>3个月）患者从初级保健中心转诊至风湿病科的策略，这与轴性脊柱关节炎的诊断有关。
每个初级保健中心为其患者分配一种转诊策略：(a) 策略1，符合以下3项标准之一的患者：炎性背痛、HLA-B27阳性或影像学显示骶髂关节炎；或(b) 策略2，符合以下6项中的2项的患者：炎性背痛、HLA-B27阳性、影像学显示骶髂关节炎、轴性脊柱关节炎家族史、关节外表现或对非甾体抗炎药反应良好。风湿病专科医生确定最终诊断。
88名西班牙患者（平均年龄36.8岁[标准差8.7]，女性占55.7%，男性占44.3%）被转诊进行评估，60名患者采用策略1，28名患者采用策略2。策略1组中25.4%的患者被确诊为轴性脊柱关节炎，策略2组中这一比例为28.6%（p=无统计学意义）。炎性背痛是最常被用于转诊的标准，初级保健医生与风湿病专科医生之间的一致率为75%。
在诊断轴性脊柱关节炎方面，基于3项标准之一的简单转诊策略与基于6项标准中的2项的策略同样有效。炎性背痛是最常被用于患者转诊的标准。
