Magrey Marina, Yi Esther, Wolin Daniel, Price Mark, Chirila Costel, Davenport Eric, Park Yujin
Case Western Reserve University, Cleveland, Ohio.
Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.
ACR Open Rheumatol. 2020 Oct;2(10):616-626. doi: 10.1002/acr2.11179. Epub 2020 Oct 7.
Early diagnosis of ankylosing spondylitis (AS) remains challenging because of the high prevalence of chronic back pain in patients initially treated by nonrheumatology health care providers (HCPs). We assessed the patient pathway to rheumatology referral, including HCP recognition of inflammatory back pain (IBP) and other features suggestive of AS, diagnostic workup, treatment, and referral to a specialist with the goal of identifying barriers to patient referral to a rheumatologist.
US HCPs from 10 specialties were invited to participate in a cross-sectional web-based survey on clinical characteristics and diagnostic measures leading to IBP suspicion and the subsequent referral process. Eligible HCPs were actively practicing and had referred a patient with suspected IBP or ocular findings (ophthalmology only) within 12 months. Data were analyzed descriptively.
Of 1690 HCPs, 61% identified morning stiffness lasting more than 30 minutes, 29% sleep disturbance due to back pain, and 28% pain that improves with activity as features suggestive of IBP. Nearly two-thirds of primary care HCPs reported that they were the first HCPs consulted by patients with suspected IBP. Among HCPs ordering diagnostic blood work, approximately 90% selected antinuclear antibody and rheumatoid factor, whereas 76% selected human leukocyte antigen B27. Almost 40% would treat patients with suspected IBP themselves. HCPs cited lack of adequate specialists nearby (35.1%), insurance restrictions (47.1%), and long wait time (77.0%) as barriers to early referral.
Most HCPs had difficulty identifying features suggestive of IBP and indicated insurance restrictions and long wait times as barriers to early referral of patients with potential AS.
由于最初由非风湿病医疗服务提供者（HCPs）治疗的患者中慢性背痛的患病率很高，强直性脊柱炎（AS）的早期诊断仍然具有挑战性。我们评估了患者转诊至风湿病专科的流程，包括HCPs对炎性背痛（IBP）和其他提示AS的特征的识别、诊断检查、治疗以及转诊至专科医生，目的是确定患者转诊至风湿病专科医生的障碍。
邀请来自10个专业的美国HCPs参加一项基于网络的横断面调查，该调查涉及导致IBP怀疑的临床特征和诊断措施以及随后的转诊过程。符合条件的HCPs为正在执业且在12个月内转诊过疑似IBP或眼部检查结果（仅眼科）患者的医生。对数据进行描述性分析。
在1690名HCPs中，61%识别出持续超过30分钟的晨僵，29%识别出因背痛导致的睡眠障碍，28%识别出活动后疼痛改善作为提示IBP的特征。近三分之二的初级保健HCPs报告称，他们是疑似IBP患者咨询的首位HCPs。在开具诊断性血液检查的HCPs中，约90%选择了抗核抗体和类风湿因子，而76%选择了人类白细胞抗原B27。近40%的HCPs会自行治疗疑似IBP的患者。HCPs将附近缺乏足够的专科医生（35.1%）、保险限制（47.1%）和等待时间长（77.0%）列为早期转诊的障碍。
大多数HCPs难以识别提示IBP的特征，并指出保险限制和等待时间长是潜在AS患者早期转诊的障碍。
