Objective To assess the prevalence of undiagnosed axial spondyloarthritis (axSpA) in patients attending chiropractic clinics (CCs) with chronic back pain (CBP), using the Assessment of Spondyloarthritis International Society (ASAS) referral strategy. Methods An observational study of adults attending one of four CCs between November 2020–2021 with CBP starting before age of 45, without prior diagnosis of spondyloarthritis (SpA). Patients fulfilling ≥ 1 feature of SpA (Inflammatory back pain [IBP], a family history of SpA, inflammatory bowel disease, psoriasis, good response to NSAIDs, history of heel pain, uveitis, or peripheral arthritis) were referred to rheumatologists. Rheumatology assessment included medical history (telephone interview), laboratory tests (CRP, HLA-B27), x-ray, and MRI of sacroiliac joints. Results Overall, 3,017 visits in 426 patients were recorded. Seven of the top ten primary complaints were related to spine pain. Of 115 patients referred, 74 were eligible, 59 (79.7%) reported to have IBP. Eight of 65 (12.3%) rheumatologist-assessed patients were diagnosed with SpA [5 (7.7%) as non-radiographic axSpA (nr-axSpA), 1 (1.5%) radiographic axSpA, 1 (1.5%) peripheral SpA (all except 1 fulfilled ASAS classification criteria), and 1 (1.5%) psoriatic arthritis (fulfilled Classification Criteria for Psoriatic Arthritis)]. Objective SpA features (imaging, presence of psoriasis, and positive HLA-B27) had the highest positive likelihood ratio. Conclusion Twelve percent of patients with CBP referred from CCs using the ASAS referral strategy were found to have undiagnosed SpA, with nr-axSpA being the most common. Further educational efforts and targeted referral strategies in CCs may allow for earlier intervention, improved health outcomes, and cost savings.<Table Float="No" ID="Taba"> <tgroup cols="2"> <colspec align="left" colname="c1" colnum="1" /> <colspec align="left" colname="c2" colnum="2" /> <tbody> <row> <entry nameend="c2" namest="c1"> Key Points • Patients with chronic back pain (CBP) with spondyloarthritis (SpA) features require prompt referral to rheumatologists for early diagnosis and improved treatment outcomes. However, these patients are often overlooked in primary care and chiropractic offices where CBP is initially seen. • The aim of this study was to assess the prevalence of undiagnosed axial spondyloarthritis (axSpA) in patients attending chiropractic clinics with CBP, using the Assessment of Spondyloarthritis International Society (ASAS) referral strategy. • The study found that over 12% of included patients with CPB had undiagnosed SpA and 9% undiagnosed axSpA, with non-radiographic axSpA being the most common. • Educational efforts and targeted referral strategies in chiropractic clinics could improve health outcomes for patients with unrecognized SpA. </entry> </row> </tbody> </tgroup> </Table>

Prevalence of axial spondyloarthritis (axSpA) in patients treated for chronic back pain in chiropractic clinics: the oregon chiropractic axial spondyloarthritis study (ORCAS)

期刊论文
发表日期：

2025年8月27日

查看全文

Atul Deodhar,
Shireesh Bhalerao,
Sonam Kiwalkar,
Kim Phung Nguyen,
Rosy Quinn,
William Malatestinic,
Theresa Hunter Gibble,
Johan Dalén,
Pragya Khurana,
Rebecca Bolce

摘要

Objective

To assess the prevalence of undiagnosed axial spondyloarthritis (axSpA) in patients attending chiropractic clinics (CCs) with chronic back pain (CBP), using the Assessment of Spondyloarthritis International Society (ASAS) referral strategy.

Methods

An observational study of adults attending one of four CCs between November 2020–2021 with CBP starting before age of 45, without prior diagnosis of spondyloarthritis (SpA). Patients fulfilling ≥ 1 feature of SpA (Inflammatory back pain [IBP], a family history of SpA, inflammatory bowel disease, psoriasis, good response to NSAIDs, history of heel pain, uveitis, or peripheral arthritis) were referred to rheumatologists. Rheumatology assessment included medical history (telephone interview), laboratory tests (CRP, HLA-B27), x-ray, and MRI of sacroiliac joints.

Results

Overall, 3,017 visits in 426 patients were recorded. Seven of the top ten primary complaints were related to spine pain. Of 115 patients referred, 74 were eligible, 59 (79.7%) reported to have IBP. Eight of 65 (12.3%) rheumatologist-assessed patients were diagnosed with SpA [5 (7.7%) as non-radiographic axSpA (nr-axSpA), 1 (1.5%) radiographic axSpA, 1 (1.5%) peripheral SpA (all except 1 fulfilled ASAS classification criteria), and 1 (1.5%) psoriatic arthritis (fulfilled Classification Criteria for Psoriatic Arthritis)]. Objective SpA features (imaging, presence of psoriasis, and positive HLA-B27) had the highest positive likelihood ratio.

Conclusion

Twelve percent of patients with CBP referred from CCs using the ASAS referral strategy were found to have undiagnosed SpA, with nr-axSpA being the most common. Further educational efforts and targeted referral strategies in CCs may allow for earlier intervention, improved health outcomes, and cost savings.

Key Points

• Patients with chronic back pain (CBP) with spondyloarthritis (SpA) features require prompt referral to rheumatologists for early diagnosis and improved treatment outcomes. However, these patients are often overlooked in primary care and chiropractic offices where CBP is initially seen.

• The aim of this study was to assess the prevalence of undiagnosed axial spondyloarthritis (axSpA) in patients attending chiropractic clinics with CBP, using the Assessment of Spondyloarthritis International Society (ASAS) referral strategy.

• The study found that over 12% of included patients with CPB had undiagnosed SpA and 9% undiagnosed axSpA, with non-radiographic axSpA being the most common.

• Educational efforts and targeted referral strategies in chiropractic clinics could improve health outcomes for patients with unrecognized SpA.