More Collaboration Between Rheumatologists and Primary Care Doctors May Speed Up Axial Spondyloarthritis Diagnosis

Suspect you could have axial spondyloarthritis or ankylosing spondylitis? Learn more here about symptoms, getting diagnosed, and more.

Chronic back pain is a hallmark of axial spondyloarthritis (axSpA), a degenerative inflammatory disorder that primarily impacts the lower spine. The catch is that back pain has a long list of other possible causes (sitting too much, stress, injuries, etc.), so determining if your back pain is the result of axSpA can be challenging. Most causes of back pain are mechanical (due to an injury or disc issue, say) rather than from inflammation from an overactive immune system, which is the culprit in axial spondyloarthritis.

But while inflammatory back pain has some unique traits and symptoms that can help accelerate being diagnosed with it, many people with back pain don’t know about inflammatory back pain or how it’s different from mechanical back pain and are unfamiliar with axial spondyloarthritis, which makes it hard to discuss this with your doctor as a potential reason for your symptoms.

It’s no wonder that it typically takes six to nine years from the onset of symptoms before a patient gets correctly diagnosed with axSpA, according to the American Journal of Accountable Care. This diagnostic delay is a problem not only because of patients’ pain — which can be very debilitating — but because the disease can continue to progress when it is not properly treated. This can lead to permanent damage and affect long-term function and mobility.

So, how can the health care system get people with axSpA diagnosed and treated sooner? This is a question many have been trying to answer for some time. But a recent study from Toronto-based researchers suggests bringing specially trained physiotherapists into the mix may help.

For the study, which was published in the journal Arthritis Care & Research, researchers analyzed data from a group of 405 adults with chronic lower back pain who underwent a primary and secondary screening for their pain. All patients were first seen by a primary care physician, but those who were younger than 50 and had had back pain for more than three months were also screened by a physiotherapist with advanced rheumatology training.

The physiotherapist screened each patient and determined whether they were no, low, medium, or high risk for axSpA. Those who received a second screening were also assessed by a rheumatologist to make sure that both the physiotherapist and rheumatologist would reach a similar conclusion in terms of likely diagnosis and next steps.

“Patients deemed by the rheumatologist to require further investigations underwent MRI and then received final diagnosis by the rheumatologist,” say study coauthors Laura Passalent, MHSc, and Y. Raja Rampersaud, MD. “The goal going forward would be that only patients who have a moderate or high risk of axSpA would go on to see the rheumatologist in an expedited manner.”

Of the patients who were screened, 15.6 percent received a final diagnosis of axSpA.

Those who were diagnosed with non-radiographic axSpA received the diagnosis within two years of symptom onset, while those who diagnosed with radiographic axSpA received the diagnosis within seven years — two years less than the average diagnosis time with traditional screening approaches.

This study shows that a collaborative screening model might reduce the time to diagnosis by several years.

“The sooner patients with inflammatory back pain can been evaluated by knowledgeable health care providers, the sooner they can receive appropriate treatment interventions,” say the study authors. “This study demonstrates the positive impact of a collaborative shared care approach to patients with symptoms suggestive of inflammatory back pain by expediting the gap between primary and specialty care.”

Not Sure What’s Causing Your Back Pain?

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