Division of Rheumatology, Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York.
Division of Rheumatology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
Curr Opin Rheumatol. 2021 Jul 1;33(4):313-318. doi: 10.1097/BOR.0000000000000806.
Axial spondyloarthritis (axSpA) affects 0.5-1% of the population in many regions of the world. This review summarizes the challenges in medical education around axSpA with attention to evidence around delayed diagnosis, clinician familiarity with typical axSpA features, such as inflammatory back pain and adherence to accepted management principles.
Clinicians who commonly manage patients with chronic back pain or other typical axSpA features are not consistently aware of the concept of inflammatory back pain and common extra-spinal manifestations. Further, clinicians may not be familiar with the nonradiographic spectrum of axSpA. Management of patients with possible axSpA does not consistently follow principles that would establish an axSpA diagnosis, and diagnosis of axSpA remains delayed by 6-7 years on average, with evidence suggesting management disparities on the basis of sex and race in some cases. Referral recommendations have increased the probability of axSpA diagnosis up to about 40% and, may complement educational efforts in axSpA.
Educational efforts in axSpA should focus on providing front-line clinicians with a better understanding of inflammatory back pain, the nonradiographic form of axSpA, and accepted principles in axSpA management.
在世界许多地区，强直性脊柱炎（axSpA）影响了 0.5%-1%的人群。本综述总结了 axSpA 医学教育方面的挑战，重点关注了延迟诊断、临床医生对典型 axSpA 特征（如炎症性背痛）的熟悉程度以及对公认的管理原则的遵循情况。
尽管经常管理慢性背痛或其他典型 axSpA 特征的患者的临床医生并不总是了解炎症性背痛和常见的脊柱外表现的概念。此外，临床医生可能不熟悉 axSpA 的非放射学谱。对可能患有 axSpA 的患者的管理并不总是遵循可确立 axSpA 诊断的原则，axSpA 的诊断平均延迟了 6-7 年，有证据表明在某些情况下，性别和种族的管理差异。推荐转诊的建议将 axSpA 的诊断概率提高了约 40%，并可能补充 axSpA 方面的教育工作。
axSpA 的教育工作应侧重于使一线临床医生更好地了解炎症性背痛、axSpA 的非放射学形式以及 axSpA 管理的公认原则。
