Rheumatologists and Primary Care Physicians Collaborate for Swift Axial Spondyloarthritis Diagnosis

Axial spondyloarthritis (axSpA), a degenerative inflammatory disorder primarily affecting the lower spine, is characterized by chronic back pain. The catch is that back pain has a long list of other potential causes (sitting too much, stress, injuries, and so forth.), so deciding whether your back aggravation is the consequence of axSpA can challenge. Most reasons for back pain are mechanical (because of an injury or disc issue, say) as opposed to from inflammation from an overactive immune system, which is the culprit in axial spondyloarthritis.

Yet, while inflammatory back pain has a few remarkable traits and symptoms that can help speed up being diagnosed with it, many individuals with back pain have barely any insight into inflammatory back pain or how it’s not quite the same as mechanical back pain and are new to axial spondyloarthritis, which makes it hard to examine this with your PCP as a possible justification behind your symptoms.

According to the American Journal of Accountable Care, it is not surprising that a patient may not receive a correct diagnosis of axSpA until six to nine years after the onset of symptoms. This symptomatic deferral is an issue not just due to patients’ pain — which can be very debilitating — but since the illness can keep on advancing when it isn’t as expected treated. This can prompt extremely durable harm and influence long-term function and mobility.

So, how can people with axSpA be diagnosed and treated earlier in the healthcare system? Many people have been trying to find an answer to this question for some time. However, a recent study by researchers in Toronto suggests that incorporating specially trained physiotherapists may be beneficial.

For the study, which was published in the journal Arthritis Care & Research, specialists analyzed information from a group of 405 adults with chronic lower back pain who underwent a primary and secondary screening for their pain. Primary care physicians saw every patient first, but a physiotherapist with advanced rheumatology training also checked out those under 50 who had back pain for more than three months.

The physiotherapist screened every patient and decided if they were no, low, medium, or high risk for axSpA. The people who got a second screening were likewise surveyed by a rheumatologist to ensure that both the physiotherapist and rheumatologist would arrive at a comparative resolution concerning 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.”

15.6 percent of the patients who underwent the screening received a definitive diagnosis of axSpA.

Those who were diagnosed with non-radiographic axSpA did so within two years of the onset of symptoms, whereas those who were diagnosed with radiographic axSpA did so within seven years. This is two years shorter than the average amount of time it takes to receive a diagnosis using traditional screening methods.

This study shows that a collaborative screening model could decrease 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.”