Danve Abhijeet, Alexander Swetha, Afinogenova Yuliya, Haims Andrew, Park Hong-Jai, Maciejewski Kaitlin R, Deng Yanhong, Odell William, Page Nicolas, Kang Insoo
Department of Medicine, Yale School of Medicine, New Haven, CT, USA.
Department of Medicine, University of Utah Health, Salt Lake City, UT, USA.
Rheumatol Adv Pract. 2025 Jul 28;9(3):rkaf086. doi: 10.1093/rap/rkaf086. eCollection 2025.
Lack of timely referral of suspected axial spondyloarthritis (axSpA) patients to rheumatologists is an important modifiable reason for diagnostic delay of axSpA. We assessed the usefulness of a self-referral strategy using a clinical feature-based screening questionnaire (SQ) (A-tool).
Finding axSpA (FaxSpA) was single-centre prospective study involving patients with chronic back pain (CBP). The A-tool, consisting of a three-question prescreen and eight-question SQ, was distributed to patients via the patient communication portal and university Facebook page. Patients with affirmative responses on all three prescreen questions, and three or more questions on SQ were eligible for study visit. Enrolled patients underwent history, physical examination, labs (CRP and HLA-B27) and imaging studies (X-ray and MRI of the pelvis). The clinician's judgement was considered the gold standard for diagnosing axSpA.
Eighty-six of the 100 enrolled patients completed all the study procedures, and 29 (34%) were diagnosed with axSpA. Seven patients had AS, and 22 had non-radiographic axSpA. Sensitivity and specificity of the individual A-tool questions for diagnosing axSpA ranged from 0.03 to 0.86 and 0.14 to 0.96, respectively. Positive likelihood ratios (+LR) of the individual items in the A-tool ranged from 0.84 to 1.34. There was low to moderate agreement between the patient responses on the online A-tool and the corresponding physician-confirmed responses.
A tool-based strategy for self-referral of CBP patients is a simple, practical and feasible approach for early diagnosis of axSpA. We need a larger prospective study to validate our findings.
疑似中轴型脊柱关节炎（axSpA）患者未及时转诊至风湿病专科医生处是axSpA诊断延迟的一个重要且可改变的原因。我们评估了使用基于临床特征的筛查问卷（SQ）（A工具）进行自我转诊策略的有效性。
发现axSpA（FaxSpA）是一项单中心前瞻性研究，纳入慢性背痛（CBP）患者。A工具由三个问题的预筛查和八个问题的SQ组成，通过患者交流平台和大学脸书页面分发给患者。在所有三个预筛查问题上回答为肯定，且在SQ上回答三个或更多问题的患者有资格参加研究访视。入组患者接受了病史采集、体格检查、实验室检查（CRP和HLA - B27）以及影像学检查（骨盆X线和MRI）。临床医生的判断被视为诊断axSpA的金标准。
100名入组患者中有86名完成了所有研究程序，其中29名（34%）被诊断为axSpA。7名患者患有强直性脊柱炎（AS），22名患有非放射学axSpA。A工具中各个问题诊断axSpA的敏感性和特异性分别为0.03至0.86和0.14至0.96。A工具中各个项目的阳性似然比（+LR）范围为0.84至1.34。患者在在线A工具上的回答与相应医生确认的回答之间的一致性为低到中度。
基于工具的CBP患者自我转诊策略是axSpA早期诊断的一种简单、实用且可行的方法。我们需要更大规模的前瞻性研究来验证我们的发现。
