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Bray TJP, Eddison J, Hamilton J, Webb D, Bennett A, Machado PM, Gaffney K, Sengupta R, Hall-Craggs MA, Marzo-Ortega H. Evaluation of the current use of MRI to aid the diagnosis of axial spondyloarthritis in the UK: results from a freedom of information request. Clin Radiol 2024; 79:107-116. [PMID: 37968226 DOI: 10.1016/j.crad.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/26/2023] [Accepted: 10/05/2023] [Indexed: 11/17/2023]
Abstract
AIM To evaluate the impact of recommendations from the 2019 consensus exercise conducted by radiologists and rheumatologists on the use of magnetic resonance imaging (MRI) to investigate axial spondyloarthritis (axSpA) in clinical practice. MATERIALS AND METHODS A freedom of information (FOI) request was used to assess the use of MRI in the diagnosis of axSpA and radiologists' awareness of the 2019 guidance across all NHS Trusts and Health Boards in the UK, including England, Scotland, Northern Ireland, and Wales. RESULTS The FOI request was sent to 150 Trusts/Health Boards, and 93 full responses were received. Of the 93 respondents (97%), 90 reported familiarity with the term axSpA and 70/93 (75%) reported familiarity with the 2019 recommendations. Awareness of recommendations regarding specific MRI features supportive of the diagnosis of axSpA was 74/93 (80%) for the sacroiliac joints (SIJs) and 66/93 (71%) for the spine. The median wait for MRI acquisition was 2-3 months. Fifty-two of the 93 (56%) reported at least some outsourcing of axSpA MRI (33%/29% for specialist/non-specialist outsourcing respectively); 32/93 (34%) reported some scans being reported in-house by non-musculoskeletal radiologists. CONCLUSION There have been several positive developments in the understanding and use of MRI for the diagnosis of axSpA in the UK since the 2017 survey, although substantial scope for further improvement remains. Several new challenges have also emerged, including the increase in waiting times, reliance on outsourcing, and the reporting of MRI by non-musculoskeletal radiologists.
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Affiliation(s)
- T J P Bray
- Centre for Medical Imaging, University College London, London, UK; Department of Imaging, University College London Hospital, London, UK.
| | - J Eddison
- National Axial Spondyloarthritis Society, London, UK
| | - J Hamilton
- National Axial Spondyloarthritis Society, London, UK
| | - D Webb
- National Axial Spondyloarthritis Society, London, UK
| | - A Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Unit, Loughborough, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - P M Machado
- Centre for Rheumatology & Department of Neuromuscular Diseases, University College London, London, UK
| | - K Gaffney
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - R Sengupta
- Royal National Hospital for Rheumatic Diseases and University of Bath, Bath, UK
| | - M A Hall-Craggs
- Centre for Medical Imaging, University College London, London, UK; Department of Imaging, University College London Hospital, London, UK
| | - H Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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2
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Jamal M, Kuijper TM, Hazes J, Lopes Barreto D, Weel A. A trial-based economic evaluation of the CaFaSpA referral strategy for axial spondyloarthritis. Scand J Rheumatol 2024; 53:1-9. [PMID: 37650240 DOI: 10.1080/03009742.2023.2243081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To assess the cost-utility from healthcare and societal perspectives of the digital CaFaSpA referral strategy (CS) for axial spondyloarthritis (axSpA) in primary care patients with chronic low back pain (CLBP). METHOD A cluster randomized controlled trial was performed in the Netherlands. General practice units were randomized into CS or usual care (UC). Economic evaluation was performed from the healthcare and societal perspectives within a 12-month time horizon. Outcome measures encompassed disability [Roland-Morris Disability Questionnaire (RMDQ)] and health-related quality of life (EQ-5D-3L). Direct medical (iMTA Medical Consumption Questionnaire) and indirect costs (iMTA Productivity Cost Questionnaire), including productivity loss, were evaluated. Incremental cost-utility ratios (ICURs) were calculated. RESULTS The study included 90 GP clusters with 563 patients (CS: n = 260; UC: n = 303) (mean ± sd age 36.3 ± 7.5 years; 66% female). After 12 months, no minimal important differences in outcomes were observed for RMDQ (-0.21, 95%CI -1.52 to 1.13) or EQ-5D (-0.02, 95%CI -0.08 to 0.05). However, total costs were significantly lower in the CS group owing to lower productivity loss costs. The ICUR for RMDQ was €18,059 per point decrease and €220,457 per quality-adjusted life year increase. CONCLUSIONS Digital referral did not decrease the overall healthcare status of patients after 1 year of follow-up and appears to be more cost-effective than UC. Therefore, CS can be used as an appropriate primary care referral model for CLBP patients at risk for axSpA. This will accelerate timely provision of care by the right caregiver.
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Affiliation(s)
- M Jamal
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - T M Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jmw Hazes
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - D Lopes Barreto
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Aeam Weel
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Health Technology Assessment, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands
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3
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Hepburn J. Advanced practice physiotherapists in Scottish primary care: Axial Spondyloarthropathy epidemiology, time to diagnosis, and referrals to rheumatology. Musculoskeletal Care 2023; 21:958-967. [PMID: 37186356 DOI: 10.1002/msc.1769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 03/29/2023] [Accepted: 04/05/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES (1) Generate empirical knowledge of a Musculoskeletal (MSK) Advanced Practice Physiotherapist (APP) Service in Scottish Primary Care; (2) Identify the incidence and baseline time to diagnosis of Axial Spondyloarthropathy (AxSpA); (3) Identify APP Rheumatology referral fulfilment of the NICE 2017 Guidelines and Spondylarthritis Diagnosis Evaluation (SPADE) Tool; (4) Calculate APP Rheumatology referral conversion rates for AxSpA diagnosis and further investigation; (5) Contribute towards the current body of literature for informing analysis of MSK APP services within Scottish Primary Care. METHODS An audit and evaluation approach was undertaken over a 3-year period (May 2019-April 2022). Relevant clinical cases from the whole-service data-set were identified and analysed, using retrospective electronic healthcare record review and descriptive statistical techniques. RESULTS A total of 37,656 primary care MSK APP consultations took place, with N = 19 suspected AxSpA referrals made to Rheumatology. N = 6 cases of AxSpA were diagnosed by a Rheumatologist (31.6%). The mean age of individuals diagnosed with AxSpA was 39.6 ± 8.8, and 66.7% (4/6) were female. Mean time to diagnosis was 3.4 years, and incidence per-10,000 person-years was 1.6. Compliance of referrals with the NICE 2017 Guidelines and SPADE Tool Criteria was 78.9%. Of those diagnosed with AxSpA, 66.7% met both referral criterion sets. CONCLUSION Those referred by an MSK APP from primary care had a 5.1 year shorter time to diagnosis than the previous reported UK average of 8.5 years. APPs identified relevant AxSpA features in referring to Rheumatology, and supported effective implementation of the local secondary care pathway.
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Affiliation(s)
- Jordan Hepburn
- General Practice, Primary Care, Edinburgh Health & Social Care Partnership, NHS Lothian, Edinburgh, UK
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4
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Barnett R, Gaffney K, Sengupta R. Diagnostic delay in axial spondylarthritis: A lost battle? Best Pract Res Clin Rheumatol 2023; 37:101870. [PMID: 37658016 DOI: 10.1016/j.berh.2023.101870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/08/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
Diagnostic delay in axial spondylarthritis (axSpA) remains an unacceptable worldwide problem; with evidence suggesting significant detrimental impact both clinically on the individual, and economically on society. There is therefore, a need for global action across various healthcare professions that come into contact with patients living, and suffering, with undiagnosed axSpA. Recent estimates of the median diagnostic delay suggest that globally, individuals with axSpA wait between 2 and 6 years for a diagnosis - revealing a clear benchmark for improvement. This timespan presents a window of opportunity for earlier diagnosis and intervention, which will likely improve patient outcomes. This review describes the current diagnostic delay as estimated across countries and over time, before presenting evidence from published strategies that may be implemented to improve this delay across primary and secondary care, including for specialties treating extra-musculoskeletal manifestations of axSpA (ophthalmology, gastroenterology, dermatology). Ongoing campaigns tackling delayed diagnosis in axSpA are also highlighted.
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Affiliation(s)
- Rosemarie Barnett
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK; Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
| | - Karl Gaffney
- Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk & Norwich, University Hospital, Colney Lane, Norwich NR4 7UY, UK.
| | - Raj Sengupta
- Rheumatology Department, Royal National Hospital for Rheumatic Diseases & Brownsword Therapies Centre, Royal United Hospitals Bath NHS Foundation Trust, Combe Park, Bath, BA1 3NG, UK.
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5
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Shrestha S, Brand JS, Järås J, Schoultz I, Montgomery S, Askling J, Ludvigsson JF, Olen O, Halfvarson J. Association Between Inflammatory Bowel Disease and Spondyloarthritis: Findings from a Nationwide Study in Sweden. J Crohns Colitis 2022; 16:1540-1550. [PMID: 35512691 PMCID: PMC9624287 DOI: 10.1093/ecco-jcc/jjac065] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 04/02/2022] [Accepted: 05/02/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Inflammatory bowel disease [IBD] has been associated with spondyloarthritis [SpA], but population-based estimates are scarce. Here we compare the occurrence of SpA before and after a diagnosis of IBD with the general population, overall and by IBD subtype and age. METHODS We used a nationwide register-based cohort study of 39 203 patients diagnosed with IBD during 2006-2016, identified from Swedish registers and gastrointestinal biopsy data, and 390 490 matched reference individuals from the general population. Conditional logistic regression models were used to estimate odds ratios [ORs] for a prior [prevalent] SpA diagnosis and conditional Cox regression to calculate hazard ratios [HRs] for a subsequent [incident] SpA diagnosis in IBD patients. RESULTS IBD patients were more likely to have prevalent SpA at IBD diagnosis [2.5%] compared with reference individuals [0.7%] with an OR of 3.48 [95% CI: 3.23, 3.75]. They also more often received an incident diagnosis of SpA; during 23 341 934 person-years of follow-up in IBD patients, there were 1030 SpA events [5.0/1000 person-years] compared with 1524 SpA events in the reference group [0.72/1000 person-years], corresponding to an HR of 7.15 [95% CI: 6.60, 7.75]. In subgroup analyses, associations were most pronounced among patients with Crohn's disease ([OR = 5.20; 95% CI: 4.59, 5.89], and [HR = 10.55; 95% CI: 9.16, 12.15]) and paediatric onset IBD ([OR = 3.63; 95% CI: 2.35, 5.59] and [HR = 15.03; 95% CI: 11.01, 20.53]). CONCLUSIONS IBD patients more frequently experience SpA both before and after the diagnosis of IBD compared with the general population, supporting evidence of a shared pathophysiology. The variation in SpA comorbidity, across IBD subtypes and age groups, calls for targeted approaches to facilitate timely diagnosis and intervention.
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Affiliation(s)
- Sarita Shrestha
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Judith S Brand
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK,Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK,Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden
| | - Jacob Järås
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ida Schoultz
- School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University Hospital, Örebro, Sweden,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Epidemiology and Public Health, University College London, London, UK
| | - Johan Askling
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Rheumatology, Theme Inflammation and Ageing, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Pediatrics, Orebro University Hospital, Orebro, Sweden,Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ola Olen
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden,Sachs’ Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
| | - Jonas Halfvarson
- Corresponding author: Prof. Jonas Halfvarson, Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, SE 70182 Örebro, Sweden.
| | - SWIBREG Study Group
OlssonMalinDepartment of Surgery, County Council of Östergötland, Linköping, SwedenHjortswangHenrikDepartment of Gastroenterology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, SwedenMyrelidParDepartment of Surgery, County Council of Östergötland, Linköping, SwedenBengtssonJonasDepartment of Surgery, Sahlgrenska University Hospital/Östra, Gothenburg, SwedenStridHansDepartment of Internal Medicine, Södra Älvsborgs Hospital, Borås, SwedenAnderssonMarieDepartment of Internal Medicine, Södra Älvsborgs Hospital, Borås, SwedenJäghultSusannaStockholm Gastro Center, Karolinska Institutet, Stockholm, SwedenEberhardsonMichaelDepartment of Medicine, Karolinska Institutet, Stockholm, SwedenNordenvallCarolineDepartment of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, SwedenDepartment of Colorectal Cancer, Karolinska University Hospital, Stockholm, SwedenFagerbergUlrika LCenter for Clinical Research, Västmanland Hospital, Västerås, Sweden and Uppsala University, Uppsala, SwedenDepartment of Pediatrics, Västmanland Hospital, Västerås, SwedenDepartment of Women´s and Children´s Health, Karolinska Institutet, Stockholm, SwedenRejlerMartinDepartment of Medicine, Höglandssjukhuset Eksjö, Region Jönköping County Council, Jönköping, SwedenJönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, SwedenGripOlofDepartment of Gastroenterology, Skåne University Hospital, Malmö, SwedenKarlingPontusDepartment of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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6
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Hay CA, Packham J, Ryan S, Mallen CD, Chatzixenitidis A, Prior JA. Diagnostic delay in axial spondyloarthritis: a systematic review. Clin Rheumatol 2022; 41:1939-1950. [PMID: 35182270 PMCID: PMC9187558 DOI: 10.1007/s10067-022-06100-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 12/23/2022]
Abstract
Identification of axial spondyloarthritis (axSpA) remains challenging, frequently resulting in a diagnostic delay for patients. Current benchmarks of delay are usually reported as mean data, which are typically skewed and therefore may be overestimating delay. Our aim was to determine the extent of median delay patients’ experience in receiving a diagnosis of axSpA and examine whether specific factors are associated with the presence of such delay. We conducted a systematic review across five literature databases (from inception to November 2021), with studies reporting the average time period of diagnostic delay in patients with axSpA being included. Any additional information examining associations between specific factors and delay were also extracted. A narrative synthesis was used to report the median range of diagnostic delay experienced by patients with axSpA and summarise which factors have a role in the delay. From an initial 11,995 articles, 69 reported an average time period of diagnostic delay, with 25 of these providing a median delay from symptom onset to diagnosis. Across these studies, delay ranged from 0.67 to 8 years, with over three-quarters reporting a median of between 2 years and 6 years. A third of all studies reported median delay data ranging from just 2 to 2.3 years. Of seven variables reported with sufficient frequency to evaluate, only ‘gender’ and ‘family history of axSpA’ had sufficient concordant data to draw any conclusion on their role, neither influenced the extent of the delay. Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay and this remains an extensive worldwide problem. This is further compounded by a mixed picture of the disease, patient and healthcare-related factors influencing delay.Key points • Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay. • Median diagnostic delay typically ranges from 2 to 6 years globally. • Neither ‘gender’ nor ‘family history of axSpA’ influenced the extent of diagnostic delay experienced. • Diagnostic delay based on mean, rather than median, data influences the interpretation of the delay time period and consistently reports a longer delay period. |
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Affiliation(s)
- Charles A Hay
- School of Medicine, Keele University, Keele, ST5 5BG, UK
| | - Jon Packham
- School of Medicine, Keele University, Keele, ST5 5BG, UK.,Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Sarah Ryan
- Midlands Partnership NHS Foundation Trust, Stafford, UK.,School of Nursing and Midwifery, Keele University, Keele, ST5 5BG, UK
| | - Christian D Mallen
- School of Medicine, Keele University, Keele, ST5 5BG, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | | | - James A Prior
- School of Medicine, Keele University, Keele, ST5 5BG, UK. .,Midlands Partnership NHS Foundation Trust, Stafford, UK.
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7
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Roberts MJ, Leonard AN, Bishop NC, Moorthy A. Lifestyle modification and inflammation in people with axial spondyloarthropathy-A scoping review. Musculoskeletal Care 2022; 20:516-528. [PMID: 35179819 DOI: 10.1002/msc.1625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 02/12/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION People with axial spondyloarthritis (AS) have an inflammatory profile, increasing the risk of hypertension, type 2 diabetes, obesity, and dyslipidaemia. Consequently, AS is linked with co-morbidities such as cardiovascular disease (CVD). Physical inactivity, diet, smoking, alcohol consumption, and obesity influence inflammation, but knowledge of the interaction between these with inflammation, disease activity, and CVD risk in AS is dominated by cross-sectional research. METHODS A review of the literature was conducted between July 2020 and December 2021. The focus of the scoping review is to summarise longitudinal and randomised control trials in humans to investigate how tracking or modifying lifestyle influences inflammation and disease burden in patients with AS. KEY MESSAGES: (1) Lifestyle modifications, especially increased physical activity (PA), exercise, and smoking cessation, are critical in managing AS. (2) Smoking is negatively associated with patient reported outcome measures with AS, plus pharmaceutical treatment adherence, but links with structural radiographic progression are inconclusive. (3) Paucity of data warrant structured studies measuring inflammatory cytokine responses to lifestyle modification in AS. CONCLUSION Increased PA, exercise, and smoking cessation should be supported at every given opportunity to improve health outcomes in patients with AS. The link between smoking and radiographic progression needs further investigation. Studies investigating the longitudinal effect of body weight, alcohol, and psychosocial factors on disease activity and physical function in patients with AS are needed. Given the link between inflammation and AS, future studies should also incorporate markers of chronic inflammation beyond the standard C-reactive protein and erythrocyte sedimentation rate measurements.
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Affiliation(s)
- Matthew J Roberts
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Amber N Leonard
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Nicolette C Bishop
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.,National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, University Hospitals of Leicester NHS Trust and the University of Leicester, Leicester, UK
| | - Arumugam Moorthy
- Department of Rheumatology, University Hospitals of NHS Trust, College of Life Sciences, University of Leicester, Leicester, UK
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8
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Crossfield SSR, Marzo-Ortega H, Kingsbury SR, Pujades-Rodriguez M, Conaghan PG. Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades. RMD Open 2021; 7:rmdopen-2021-001888. [PMID: 34887345 PMCID: PMC8663075 DOI: 10.1136/rmdopen-2021-001888] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives To assess changes in ankylosing spondylitis (AS) incidence, prevalence and time to diagnosis, between 1998 and 2017. Methods Using UK GP data from the Clinical Practice Research Datalink, we identified patients diagnosed with AS between 1998 and 2017. We estimated the annual AS incidence, prevalence and length of time from first recorded symptom of back pain to rheumatology referral and diagnosis. Results We identified 12 333 patients with AS. The incidence declined from 0.72 (±0.14) per 10 000 patient-years in 1998 to 0.39 (±0.06) in 2007, with this decline significant only in men, then incidence rose to 0.57 (±0.11) in 2017. By contrast, prevalence increased between 1998 and 2017 (from 0.13%±0.006 to 0.18%±0.006), rising steeply among women (from 0.06%±0.05 to 0.10%±0.06) and patients aged ≥60 (from 0.14%±0.01 to 0.26%±0.01). The overall median time from first symptom to rheumatology referral was 4.87 years (IQR=1.42–10.23). The median time from first symptom to diagnosis rose between 1998 and 2017 (from 3.62 years (IQR=1.14–7.07) to 8.31 (IQR=3.77–15.89)) and was longer in women (6.71 (IQR=2.30–12.36)) than men (5.65 (IQR=1.66–11.20)). Conclusion AS incidence declined significantly between 1998 and 2007, with an increase between 2007 and 2017 that may be explained by an improvement in the recognition of AS or confidence in diagnosing AS over time, stemming from increased awareness of inflammatory back pain and the importance of early treatment. The rising AS prevalence may indicate improved patient survival. The persisting delay in rheumatology referral and diagnosis remains of concern, particularly in women.
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Affiliation(s)
- Samantha S R Crossfield
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK .,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sarah R Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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9
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Beyond the sacro-Iliac joints: Vertebral involvement in axial spondylarthritis. Eur J Radiol 2021; 144:109982. [PMID: 34717188 DOI: 10.1016/j.ejrad.2021.109982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/01/2021] [Accepted: 09/24/2021] [Indexed: 11/22/2022]
Abstract
Imaging plays a central role in the diagnosis of axial spondylarthritis (axSpA). Commonly the sacroiliac joints are involved but vertebral involvement can occur in isolation in 1 out of 4 patients. Recognizing vertebral involvement patterns in axSpA can help establishing a diagnosis early and initiate therapy before irreversible changes have occurred. Magnetic resonance imaging (MRI) is considered the reference standard for early detection of inflammatory changes of the disease. Aims of this review are to present an overview of the imaging findings of vertebral involvement in axSpA, and to detail the current recommendations on the role of imaging in the diagnosis of axSpA in patients with isolated vertebral involvement.
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10
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Barnett R, Ingram T, Sengupta R. Axial spondyloarthritis 10 years on: still looking for the lost tribe. Rheumatology (Oxford) 2020; 59:iv25-iv37. [PMID: 33053196 PMCID: PMC7566532 DOI: 10.1093/rheumatology/keaa472] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the publication of various recommendations, quality standards and referral strategies to promote early diagnosis in axial SpA (axSpA) over the last decade, there remains a significant delay to diagnosis, leading to a lost tribe of undiagnosed, untreated patients with persistent back pain and axSpA symptoms. This review discusses the various factors contributing to diagnostic delay in axSpA, while providing recommendations to improve the diagnostic pathway, for example use of the online Spondyloarthritis Diagnosis Evaluation (SPADE) tool (http://www.spadetool.co.uk/). Significant shortcomings exist at both the primary and secondary care level, with healthcare professionals often lacking knowledge and awareness of axSpA. Myths regarding the classical signs and symptoms still prevail, including the perception of axSpA as a male disease, only occurring in individuals who are HLA-B27 positive with raised inflammatory markers. Individuals within this lost tribe of undiagnosed patients are likely lacking adequate treatment and are thereby at risk of worse clinical outcomes. It is therefore vital that public health initiatives are implemented to improve education of healthcare professionals and to ensure early specialist referral, to ultimately improve the lives of patients with axSpA.
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Affiliation(s)
- Rosemarie Barnett
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department of Computer Science, University of Bath
| | - Thomas Ingram
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department for Health, University of Bath
| | - Raj Sengupta
- Axial Spondyloarthritis Service, Royal National Hospital for Rheumatic Diseases, Royal United Hospitals NHS Foundation Trust
- Department of Pharmacy & Pharmacology, University of Bath, Bath, UK
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11
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Jamal M, Korver AM, Kuijper M, Lopes Barreto D, Appels CWY, Spoorenberg APL, Koes BW, Hazes JMW, van Hoeven L, Weel AEAM. The IMPACT study: A clustered randomized controlled trial to assess the effect of a referral algorithm for axial spondyloarthritis. PLoS One 2020; 15:e0227025. [PMID: 31990912 PMCID: PMC6986702 DOI: 10.1371/journal.pone.0227025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 12/09/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A substantial number of patients with chronic low back pain (CLBP) have axial spondyloarthritis (axSpA), but early recognition of these patients is difficult for general practitioners (GPs). The Case Finding Axial Spondyloarthritis (CaFaSpA) referral strategy has shown to be able to identify patients with CLBP at risk for axSpA, but its impact on clinical daily practice is yet unknown. OBJECTIVE To assess the effect of the CaFaSpA referral strategy on pain caused by disability in primary care patients with CLBP. METHODS Within this clustered randomized controlled trial 93 general practices were randomized to either the CaFaSpA referral model (intervention) or usual primary care (control). In each group primary care patients between 18 and 45 years with CLBP were included. The primary outcome was disability caused by CLBP, measured with the Roland Morris Disability Questionnaire (RMDQ) at baseline and four months. Secondary outcome was the frequency of new axSpA diagnosis. Descriptive analyses were performed, and a linear mixed-effects model was used. RESULTS In total 679 CLBP patients were included of which 333 patients were allocated to the intervention group and 346 to the control group. Sixty-four percent were female and mean age was 36.2 years. The mean RMDQ score at baseline was 8.39 in the intervention group and 8.61 in the control group. At four months mean RMDQ score was 7.65 in the intervention group and 8.15 in the control group. This difference was not statistically significant (p = 0.50). Six (8%) out of the 75 finally referred patients, were diagnosed with axSpA by their rheumatologist. CONCLUSIONS The CaFaSpA referral strategy for axSpA did not have an effect on disability after four months caused by CLBP. However, the strategy is able to detect the axSpA patient within the large CLBP population sufficiently. Trial registration number: NCT01944163, Clinicaltrials.gov.
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Affiliation(s)
- Maha Jamal
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
- * E-mail:
| | - Amber M. Korver
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Martijn Kuijper
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Deirisa Lopes Barreto
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | - Anneke P. L. Spoorenberg
- Department of Rheumatology and Clinical Immunology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Bart W. Koes
- Department of General Practice, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Johanna M. W. Hazes
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Lonneke van Hoeven
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Angelique E. A. M. Weel
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
- Department of Rheumatology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
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Yong CY, Hamilton J, Benepal J, Griffiths K, Clark ZE, Rush A, Sengupta R, Martindale J, Gaffney K. Awareness of axial spondyloarthritis among chiropractors and osteopaths: findings from a UK Web-based survey. Rheumatol Adv Pract 2019; 3:rkz034. [PMID: 31616854 PMCID: PMC6785804 DOI: 10.1093/rap/rkz034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/23/2019] [Indexed: 12/28/2022] Open
Abstract
Objective Chiropractors and osteopaths are important professional partners in the management of axial spondyloarthritis (axSpA). In view of recent advances in diagnosis and treatment, we sought to understand their current knowledge and working practices. Methods A Web-based survey was advertised to chiropractors and osteopaths via the Royal College of Chiropractors and the Institute of Osteopathy. Results Of 382 completed responses [237 chiropractors (62%) and 145 osteopaths (38%)], all were familiar with AS, but only 63 and 25% were familiar with the terms axSpA and non-radiographic axSpA, respectively. Seventy-seven per cent were confident with inflammatory back pain. Respondents routinely asked about IBD (91%), psoriasis (81%), acute anterior uveitis (49%), peripheral arthritis (71%), genitourinary/gut infection (56%), enthesitis (30%) and dactylitis (20%). Eighty-seven per cent were aware of the association between axSpA and HLA-B27. Only 29% recognized that axSpA was common in women. Forty per cent recommend an X-ray (pelvic in 80%) and, if normal, 27% would recommend MRI of the sacroiliac joints and whole spine. Forty-four per cent were aware of biologic therapies. Forty-three per cent were confident with the process of onward referral to rheumatology via the general practitioner (GP). The principal perceived barrier to onward referral was reluctance by the GP to accept their professional opinion. Conclusion Overall knowledge of ankylosing spondylitis is good, but the term axSpA is poorly understood. Specific learning needs include gender preponderance, awareness of acute anterior uveitis and the availability of biological therapies. There is lack of confidence in the onward referral process to rheumatology via the GP.
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Affiliation(s)
- Cee Y Yong
- Department of Rheumatology, North West Anglia NHS Foundation Trust, Huntingdon
| | - Jill Hamilton
- National Ankylosing Spondylitis Society, Hammersmith, London
| | | | | | - Zoë E Clark
- Howe Osteopaths and Diss Osteopathy & Natural Health Clinic, Diss
| | | | - Raj Sengupta
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath
| | - Jane Martindale
- Department of Physiotherapy, Wrightington, Wigan and Leigh NHS Foundation Trust, Lancaster
| | - Karl Gaffney
- Department of Rheumatology, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK
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Aladul MI, Fitzpatrick RW, Chapman SR. The effect of new biosimilars in rheumatology and gastroenterology specialities on UK healthcare budgets: Results of a budget impact analysis. Res Social Adm Pharm 2019; 15:310-317. [DOI: 10.1016/j.sapharm.2018.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/06/2018] [Accepted: 05/14/2018] [Indexed: 01/31/2023]
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Lynde CW, Beecker J, Dutz J, Flanagan C, Guenther LC, Gulliver W, Papp K, Rahman P, Sholter D, Searles GE. Treating to Target(s) With Interleukin-17 Inhibitors. J Cutan Med Surg 2019; 23:3S-34S. [DOI: 10.1177/1203475418824565] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The treat-to-target (T2T) strategy has become established in several medical specialties as a key guidance to optimal therapeutic decision making. T2T may be effective in the assessment of the biologic class of agents called interleukin (IL)-17 inhibitors, which are emerging as a safe and effective treatment option for autoimmune inflammatory conditions such as plaque psoriasis, psoriatic arthritis (PsA), and ankylosing spondylitis (AS). Objective: The objective of this article is to use a T2T approach for the evaluation of the effectiveness and safety of IL-17 inhibitors in the management of patients with plaque psoriasis, PsA, and AS. Methods: Following a comprehensive literature search, a full-day meeting was convened to discuss and identify the T2T targets for psoriasis, PsA, and AS. Clinical trial evidence was presented for the approved IL-17 inhibitors—secukinumab, ixekizumab, and brodalumab—to assess whether these data meet T2T safety and efficacy targets. Results: All 3 approved agents were significantly superior to placebo and active controls in the achievement of T2T targets for psoriasis. Secukinumab and ixekizumab were likewise associated with significantly better outcomes than controls in the PsA targets, and secukinumab resulted in significant AS target improvements vs placebo. The IL-17 inhibitors were also associated with low rates of serious adverse events and exacerbations of common comorbid conditions. Conclusion: Phase III trial results support the T2T benefit and safety of IL-17 inhibitors according to their specific indications for the management of patients with plaque psoriasis, PsA, and AS.
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Affiliation(s)
- Charles W. Lynde
- University of Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
- Probity Medical Research, Markham, ON, Canada
| | - Jennifer Beecker
- The Ottawa Hospital, ON, Canada
- The University of Ottawa, ON, Canada
- Probity Medical Research, Ottawa, ON, Canada
| | - Jan Dutz
- University of British Columbia, Vancouver, BC, Canada
- BC Children’s Hospital Research Institute, Vancouver, BC, Canada
| | | | | | - Wayne Gulliver
- Memorial University of Newfoundland, St. John’s, NL, Canada
| | - Kim Papp
- Probity Medical Research, Waterloo, ON, Canada
| | - Proton Rahman
- Memorial University of Newfoundland, St. John’s, NL, Canada
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15
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Rosa JE, Ruta S, Bravo M, Pompermayer L, Marin J, Ferreyra-Garrot L, García-Mónaco R, Soriano ER. Value of Color Doppler Ultrasound Assessment of Sacroiliac Joints in Patients with Inflammatory Low Back Pain. J Rheumatol 2018; 46:694-700. [PMID: 30554153 DOI: 10.3899/jrheum.180550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the diagnostic value of color Doppler ultrasound (CDUS) for the detection of sacroiliitis, in patients with inflammatory back pain (IBP). METHODS Consecutive patients with IBP and suspected axial spondyloarthritis (SpA), but without a definitive diagnosis, were included. Consecutive patients with defined SpA and axial involvement were included as a control group. All patients underwent clinical evaluation, magnetic resonance imaging (MRI), and CDUS of sacroiliac joints (SIJ) within the same week. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the diagnosis of sacroiliitis by CDUS were calculated, using MRI as the gold standard. RESULTS There were 198 SIJ evaluated in 99 patients (36 with previous SpA). There were 61 men (61.6%), with a mean age of 39.8 years (SD 11.3) and median disease duration of 24 months (IQR 12-84). At the patient level, CDUS had a sensitivity of 63% (95% CI 48.7-75.7%) and a specificity of 89% (95% CI 76-96%). The PPV was 87.2% (95% CI 72.6-95.7%) and the NPV was 66.7% (95% CI 53.3-78.3%). At joint level, CDUS had a sensitivity of 60% (95% CI 49-70%) and a specificity of 93% (95% CI 88-98%). The PPV was 83% (95% CI 78-95%) and the NPV was 43% (95% CI 33-56%). The sensitivity of CDUS for the diagnosis of axial SpA was 54% (95% CI 36.6-71.2%), specificity was 82% (95% CI 63.1-93.9%), PPV was 79% (95% CI 57.8-92.9%), and NPV was 59% (95% CI 42.1-74.4%). CONCLUSION CDUS showed adequate diagnostic properties for detection of sacroiliitis and is a useful tool in patients with IBP.
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Affiliation(s)
- Javier E Rosa
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina. .,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología.
| | - Santiago Ruta
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Maximiliano Bravo
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Luciano Pompermayer
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Josefina Marin
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Leandro Ferreyra-Garrot
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Ricardo García-Mónaco
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
| | - Enrique R Soriano
- From the Rheumatology Unit, Internal Medicine Department, and the Radiology Department, Hospital Italiano de Buenos Aires; University Institute Hospital Italiano de Buenos Aires; Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología, Buenos Aires, Argentina.,J.E. Rosa, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; S. Ruta, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; M. Bravo, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Pompermayer, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; J. Marin, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; L. Ferreyra-Garrot, MD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires; R. García-Mónaco, MD, Radiology Department, Hospital Italiano de Buenos Aires; E.R. Soriano, PhD, Rheumatology Unit, Internal Medicine Department, Hospital Italiano de Buenos Aires, and University Institute Hospital Italiano de Buenos Aires, and Fundación Dr. Pedro M. Catoggio para el Progreso de la Reumatología
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Sykes MP, Hamilton L, Jones C, Gaffney K. Prevalence of axial spondyloarthritis in patients with acute anterior uveitis: a cross-sectional study utilising MRI. RMD Open 2018. [PMID: 29531779 PMCID: PMC5845401 DOI: 10.1136/rmdopen-2017-000553] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objective Acute anterior uveitis (AAU) is the most common extra-articular manifestation of axial spondyloarthritis (axSpA). In this study, patients presenting with AAU were evaluated clinically and with MRI in order to estimate the prevalence of axSpA. Methods Consecutive patients presenting to a university teaching hospital between February 2014 and March 2015 with AAU were invited to participate. Those with a history of chronic back pain (CBP) beginning <45 years were evaluated clinically and with MRI of thoracolumbar spine and sacroiliac joints. Results Of 366 patients with AAU, 57 had a pre-existing diagnosis of axSpA; 77 others fulfilled the study eligibility criteria and 73 (95%) completed the study. Seventeen patients (23.3%) were diagnosed with axSpA by an experienced rheumatologist; of these, eight were human leucocyte antigen-B27 negative. Including those with a previous diagnosis, this equates to a minimum axSpA prevalence of 20.2%; one-quarter of patients were previously undiagnosed. Conclusion This is the first study to actively search for the presence of axSpA in unselected patients presenting with AAU utilising MRI as an essential part of the assessment. There is a significant burden of undiagnosed axSpA in patients with AAU, but there does not appear to be a simple mechanism for screening. We recommend that ophthalmologists refer all patients with AAU with CBP, onset <45 years, to rheumatology for further evaluation.
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Affiliation(s)
- Mark P Sykes
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Louise Hamilton
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Colin Jones
- Department of Ophthalmology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Derakhshan MH, Pathak H, Cook D, Dickinson S, Siebert S, Gaffney K. Services for spondyloarthritis: a survey of patients and rheumatologists. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/kex518] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Mohammad H Derakhshan
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Himanshu Pathak
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Debbie Cook
- National Ankylosing Spondylitis Society, London, UK
| | | | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Karl Gaffney
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
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Lyratzopoulos G, Mendonca SC, Gildea C, McPhail S, Peake MD, Rubin G, Singh H, Hamilton W, Walter FM, Roland M, Abel GA. Associations between diagnostic activity and measures of patient experience in primary care: a cross-sectional ecological study of English general practices. Br J Gen Pract 2018; 68:e9-e17. [PMID: 29255108 PMCID: PMC5737322 DOI: 10.3399/bjgp17x694097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 07/27/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Lower use of endoscopies and urgent referrals for suspected cancer has been linked to poorer outcomes for patients with cancer; it is important to examine potential predictors of variable use. AIM To examine the associations between general practice measures of patient experience and practice use of endoscopies or urgent referrals for suspected cancer. DESIGN AND SETTING Cross-sectional ecological analysis in English general practices. METHOD Data were taken from the GP Patient Survey and the Cancer Services Public Health Profiles. After adjustment for practice population characteristics, practice-level associations were examined between the use of endoscopy and urgent referrals for suspected cancer, and the ability to book an appointment (used as proxy for ease of access), the ability to see a preferred doctor (used as proxy for relational continuity), and doctor/nurse communication skills. RESULTS Taking into account practice scores for the ability to book an appointment, practices rated higher for the proxy measure of relational continuity used urgent referrals and endoscopies less often (for example, 30% lower urgent referral and 15% lower gastroscopy rates between practices in the 90th/10th centiles, respectively). In contrast, practices rated higher for doctor communication skills used urgent referrals and endoscopies more often (for example, 26% higher urgent referral and 17% higher gastroscopy rates between practices in the 90th/10th centiles, respectively). Patients with cancer in practices that were rated higher for doctor communication skills were less likely to be diagnosed as emergencies (1.7% lower between practices in the 90th than in the 10th centile). CONCLUSION Practices where patients rated doctor communication highly were more likely to investigate and refer patients urgently but, in contrast, practices where patients could see their preferred doctor more readily were less likely to do so. This article discusses the possible implications of these findings for clinical practice.
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Affiliation(s)
- Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, UK; Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Silvia C Mendonca
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Carolynn Gildea
- National Cancer Registration and Analysis Services, Public Health England, London, UK
| | - Sean McPhail
- National Cancer Registration and Analysis Services, Public Health England, London, UK
| | - Michael D Peake
- National Cancer Registration and Analysis Services, Public Health England, London, UK; Institute for Lung Health, Department of Respiratory Medicine, University of Leicester, Leicester, UK
| | - Greg Rubin
- Institute of Health and Society, Newcastle University, UK
| | - Hardeep Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, US
| | | | | | - Martin Roland
- Cambridge Centre for Health Services Research, Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Cambridge, UK
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Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients. Rheumatol Ther 2017; 4:219-231. [PMID: 28600789 PMCID: PMC5696278 DOI: 10.1007/s40744-017-0066-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Indexed: 12/17/2022] Open
Abstract
Psoriatic arthritis (PsA) and axial spondyloarthritis (AxSpA) are both chronic, inflammatory conditions that result in a substantial burden of disease and reduced quality of life for patients. Patient involvement in developing optimal disease management strategies, including defining appropriate goals, therapies, and treatment options, as well as in setting policy priorities and agendas, is key. A working group of patient organization representatives and rheumatologists explored what patients consider to be unmet needs, important treatment gaps, and future priorities in PsA and AxSpA management. Reducing pain and fatigue, and improving physical and social functioning and work productivity were identified as important treatment goals for patients. Although the major treatment target for both PsA and AxSpA is remission, with low/minimal disease activity an alternative target for patients with established or long-standing disease, the meaning of remission from the patient’s perspective needs to be explored further as it may differ considerably from the physician’s perspective. Key recommendations from the working group to tackle unmet needs included reducing time to diagnosis, increasing patient and physician disease awareness, focusing on patients’ priorities for treatment goals, and improving patient–physician communication. By addressing these key action points moving forward, the hope is that outcomes will continue to improve for patients with PsA and AxSpA.
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Bennett AN, Marzo-Ortega H, Kaur-Papadakis D, Rehman A. The Use of Magnetic Resonance Imaging in Axial Spondyloarthritis: Time to Bridge the Gap Between Radiologists and Rheumatologists. J Rheumatol 2017; 44:780-785. [PMID: 28365579 DOI: 10.3899/jrheum.161337] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is involved in the assessment of axial spondyloarthritis (axSpA); however, anecdotal evidence suggests diverse practice among radiologists. The objective of this study was to describe current practice in the use of MRI for assessment of axSpA by UK radiologists. METHODS Six hundred ninety-nine UK radiologists were invited to complete an online survey. Availability of MR scanners, familiarity with axSpA disease-specific lesions, and MRI protocols and definitions of positive sacroiliac joint (SIJ) or spinal MRI were assessed. RESULTS Two-hundred sixty-nine radiologists (38%) from 131/180 (73%) acute UK National Health Service trusts/health boards responded. MRI waiting times < 2 months were reported by 90% of radiologists. Twenty-nine radiologists (11%) used contrast as standard, 256 (91%) used T1 and short-tau inversion recovery, and 172 (64%) also used T2 sequences. Five percent scanned only SIJ, 33% scanned SIJ and lumbar spine, 29% scanned SIJ and thoracolumbar spine, and 30% scanned SIJ and the whole spine. Mean scan time was 34 min. Eighteen percent did not use the subchondral bone marrow edema of the SIJ to help diagnose axSpA and 18% did not use the inflammatory vertebral corner lesions to assist diagnosis. Awareness of axSpA was reported by 75% of radiologists, and awareness of definitions for positive MRI of SIJ and spine by 31% and 25%, respectively. CONCLUSION These data highlight the need for better rheumatology-radiology collaboration on the identification of diagnostic axSpA MRI lesions and support the need for a consensus on the most appropriate MRI protocols for the assessment of axSpA.
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Affiliation(s)
- Alexander N Bennett
- From the Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; AbbVie Ltd., Maidenhead; Department of Radiology, Countess of Chester Hospital, Chester, UK. .,A.N. Bennett, PhD, FRCP, Consultant Rheumatologist, Academic Department of Military Rehabilitation, DMRC, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; H. Marzo-Ortega, LMS, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; D. Kaur-Papadakis, PhD, Senior Medical Science Liaison, Rheumatology, AbbVie Ltd.; A. Rehman, MRCP, FRCR, Consultant Radiologist and Divisional Medical Director, Diagnostics and Pharmacy, Department of Radiology, Countess of Chester Hospital.
| | - Helena Marzo-Ortega
- From the Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; AbbVie Ltd., Maidenhead; Department of Radiology, Countess of Chester Hospital, Chester, UK.,A.N. Bennett, PhD, FRCP, Consultant Rheumatologist, Academic Department of Military Rehabilitation, DMRC, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; H. Marzo-Ortega, LMS, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; D. Kaur-Papadakis, PhD, Senior Medical Science Liaison, Rheumatology, AbbVie Ltd.; A. Rehman, MRCP, FRCR, Consultant Radiologist and Divisional Medical Director, Diagnostics and Pharmacy, Department of Radiology, Countess of Chester Hospital
| | - Daljit Kaur-Papadakis
- From the Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre (DMRC), Headley Court, Epsom; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds; AbbVie Ltd., Maidenhead; Department of Radiology, Countess of Chester Hospital, Chester, UK.,A.N. Bennett, PhD, FRCP, Consultant Rheumatologist, Academic Department of Military Rehabilitation, DMRC, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; H. Marzo-Ortega, LMS, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; D. Kaur-Papadakis, PhD, Senior Medical Science Liaison, Rheumatology, AbbVie Ltd.; A. Rehman, MRCP, FRCR, Consultant Radiologist and Divisional Medical Director, Diagnostics and Pharmacy, Department of Radiology, Countess of Chester Hospital
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Keat A, Bennett AN, Gaffney K, Marzo-Ortega H, Sengupta R, Everiss T. Should axial spondyloarthritis without radiographic changes be treated with anti-TNF agents? Rheumatol Int 2016; 37:327-336. [DOI: 10.1007/s00296-016-3635-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 12/19/2016] [Indexed: 12/17/2022]
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Jovaní V, Blasco-Blasco M, Ruiz-Cantero MT, Pascual E. Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis. J Rheumatol 2016; 44:174-183. [PMID: 27980009 DOI: 10.3899/jrheum.160825] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases. METHODS A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model. RESULTS The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4-10.1) for women and 6.5 (5.6-7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31-0.89), indicating that men were diagnosed 0.6 year (7 months) before women. CONCLUSION Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.
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Affiliation(s)
- Vega Jovaní
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain. .,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University.
| | - Mar Blasco-Blasco
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain.,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University
| | - M Teresa Ruiz-Cantero
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain.,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University
| | - Eliseo Pascual
- From the Rheumatology Department, Alicante University General Hospital, Alicante, and Miguel Hernandez University, Alicante, Spain.,V. Jovaní, MD, Rheumatology Department, Alicante University General Hospital; M. Blasco-Blasco, MPH, Public Health Department, University of Alicante; M.T. Ruiz-Cantero, MPH, PhD, Public Health Department, University of Alicante; E. Pascual, Prof. of Medicine (Rheumatology), Miguel Hernandez University
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Liu X, Yang B, Li L, Cai B, Liao Y, Li L, Wu Z, Wang L. Association of HLA-DP/DQ and STAT4 polymorphisms with ankylosing spondylitis in Southwest China. Int Immunopharmacol 2016; 39:10-15. [PMID: 27394003 DOI: 10.1016/j.intimp.2016.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 05/27/2016] [Accepted: 06/30/2016] [Indexed: 02/06/2023]
Abstract
Ankylosing spondylitis (AS) is a highly heritable complex inflammatory arthritis disease. Genetic factors are thought to be crucial in the pathogenesis of AS. However, few data are available on the relationship between HLA-DP/DQ and STAT4 polymorphisms and AS susceptibility in the Chinese population. Therefore, we examined HLA-DP/DQ and STAT4 polymorphisms (rs3077, rs9277535, rs7453920 and rs7574865) in a total of 779 subjects, including 400 AS and 379 age- and sex-matched healthy controls in Chinese. No significant difference was observed between AS patients and healthy controls in the allele frequency of rs3077, rs9277535 and rs7574865. However, there was a significant association between the HLA-DQ rs7453920 G/A variant and AS patients, with minor allele A correlated with a reduced risk of AS (allelic frequency, adjusted OR=0.66, 95% CI=0.55-0.78, p=4.0E-06; dominant model, adjusted OR=0.75, 95% CI=0.66-0.85, p=1.1E-05). Moreover, the haplotypes block AAA and GGA in the HLA gene significantly correlated with reduced risk of AS. This is the first study demonstrating the significant associations of SNP rs7453920 and the haplotypes in the HLA gene with the risk of AS in Southwest Chinese population. This research sheds new light on the significant relationship between HLA polymorphisms and AS.
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Affiliation(s)
- Xinle Liu
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bin Yang
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lixin Li
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Bei Cai
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yun Liao
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Linhui Li
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhiqiang Wu
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Lanlan Wang
- Department of Lab Medicine, West China Hospital, Sichuan University, Chengdu, China.
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Dean LE, Macfarlane GJ, Jones GT. Differences in the prevalence of ankylosing spondylitis in primary and secondary care: only one-third of patients are managed in rheumatology. Rheumatology (Oxford) 2016; 55:1820-5. [PMID: 27354690 DOI: 10.1093/rheumatology/kew228] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Knowing not only the prevalence of SpA, but also the proportion managed in rheumatology, has implications for health care planning. The aims of this study were to determine the prevalence of SpA and the proportion managed in rheumatology and to examine differences in group characteristics. METHODS For the primary care population, we used the Primary Care Clinical Informatics Unit Research (PCCIUR) electronic primary care database, covering one-third of the Scottish population. Patients with AS, and various extraspinal manifestations were identified using Read Codes. For secondary care, we used the Scotland Registry for Ankylosing Spondylitis, which collected data on clinically diagnosed AS patients >15 years of age seen in rheumatology clinics between 2010 and 2013. Prevalence estimate denominators were computed using the adult PCCIUR and Scottish 2011 mid-year population estimates, respectively. Differences in the characteristics of both patient groups were examined using simple descriptive statistics. RESULTS The prevalence of AS in primary care was 13.4/10 000 (95% CI 12.8, 14.0) and 4.7/10 000 in rheumatology (95% CI 4.5, 4.9). Rheumatology patients were younger overall and at diagnosis (mean age 51 vs 62 years and 35 vs 38, respectively; both P < 0.001) and more likely to have a history of uveitis (34 vs 22%), IBD (12 vs 6%) and psoriasis (14 vs 6%) (all P < 0.001). CONCLUSIONS This is the first study to estimate the prevalence of clinically diagnosed AS in primary and secondary care simultaneously, indicating that only one-third of patients are managed in rheumatology. This has important ramifications for health care planning and indicates a large 'silent' proportion of patients who may have serious pathology and would benefit from additional assessment in a specialist clinic.
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Affiliation(s)
- Linda E Dean
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK Aberdeen Centre for Arthritis and Musculoskeletal Heath, University of Aberdeen, Aberdeen, UK
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK Aberdeen Centre for Arthritis and Musculoskeletal Heath, University of Aberdeen, Aberdeen, UK
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK Aberdeen Centre for Arthritis and Musculoskeletal Heath, University of Aberdeen, Aberdeen, UK.
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Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol 2016; 35:1769-76. [PMID: 26987341 PMCID: PMC4914524 DOI: 10.1007/s10067-016-3231-z] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/22/2016] [Accepted: 03/05/2016] [Indexed: 11/30/2022]
Abstract
This study aimed to identify providers involved in diagnosing ankylosing spondylitis (AS) following back pain diagnosis in the USA and to identify factors leading to the delay in rheumatology referrals. The Truven Health MarketScan® US Commercial Database was searched for patients aged 18–64 years with back pain diagnosis in a non-rheumatology setting followed by AS diagnosis in any setting during January 2000–December 2012. Patients with a rheumatologist visit on or before AS diagnosis were considered referred. Cox regression was used to determine factors associated with referral time after adjusting for age, sex, comorbidities, physician specialty, drug therapy, and imaging procedures. Of 3336 patients included, 1244 (37 %) were referred to and diagnosed by rheumatologists; the others were diagnosed in primary care (25.7 %), chiropractic/physical therapy (7 %), orthopedic surgery (3.8 %), pain clinic (3.6 %), acute care (3.4 %), and other (19.2 %) settings. Median time from back pain diagnosis to rheumatology referral was 307 days and from first rheumatologist visit to AS diagnosis was 28 days. Referred patients were more likely to be younger (hazard ratio [HR] = 0.986; p < 0.0001), male (HR = 1.15; p = 0.0163), diagnosed with uveitis (HR = 1.49; p = 0.0050), referred by primary care physicians (HR = 1.96; p < 0.0001), prescribed non-steroidal anti-inflammatory drugs (HR = 1.55; p < 0.0001), disease-modifying antirheumatic drugs (HR = 1.33; p < 0.0001), and tumor necrosis factor inhibitors (HR = 1.40; p = 0.0036), and to have had spinal/pelvic X-ray prior to referral (HR = 1.28; p = 0.0003). During 2000–2012, most patients with AS were diagnosed outside of rheumatology practices. The delay before referral to rheumatology was 10 months; AS diagnosis generally followed within a month. Earlier referral of patients with AS signs and symptoms may lead to more timely diagnosis and appropriate treatment.
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Sykes MP, Doll H, Sengupta R, Gaffney K. Delay to diagnosis in axial spondyloarthritis: are we improving in the UK?: Fig. 1. Rheumatology (Oxford) 2015; 54:2283-4. [DOI: 10.1093/rheumatology/kev288] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
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Cooksey R, Husain MJ, Brophy S, Davies H, Rahman MA, Atkinson MD, Phillips CJ, Siebert S. The Cost of Ankylosing Spondylitis in the UK Using Linked Routine and Patient-Reported Survey Data. PLoS One 2015; 10:e0126105. [PMID: 26185984 PMCID: PMC4506082 DOI: 10.1371/journal.pone.0126105] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/31/2015] [Indexed: 11/19/2022] Open
Abstract
Background Ankylosing spondylitis (AS) is a chronic inflammatory arthritis which typically begins in early adulthood and impacts on healthcare resource utilisation and the ability to work. Previous studies examining the cost of AS have relied on patient-reported questionnaires based on recall. This study uses a combination of patient-reported and linked-routine data to examine the cost of AS in Wales, UK. Methods Participants in an existing AS cohort study (n = 570) completed questionnaires regarding work status, out-of-pocket expenses, visits to health professionals and disease severity. Participants gave consent for their data to be linked to routine primary and secondary care clinical datasets. Health resource costs were calculated using a bottom-up micro-costing approach. Human capital costs methods were used to estimate work productivity loss costs, particularly relating to work and early retirement. Regression analyses were used to account for age, gender, disease activity. Results The total cost of AS in the UK is estimated at £19016 per patient per year, calculated to include GP attendance, administration costs and hospital costs derived from routine data records, plus patient-reported non-NHS costs, out-of-pocket AS-related expenses, early retirement, absenteeism, presenteeism and unpaid assistance costs. The majority of the cost (>80%) was as a result of work-related costs. Conclusion The major cost of AS is as a result of loss of working hours, early retirement and unpaid carer’s time. Therefore, much of AS costs are hidden and not easy to quantify. Functional impairment is the main factor associated with increased cost of AS. Interventions which keep people in work to retirement age and reduce functional impairment would have the greatest impact on reducing costs of AS. The combination of patient-reported and linked routine data significantly enhanced the health economic analysis and this methodology that can be applied to other chronic conditions.
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Affiliation(s)
- Roxanne Cooksey
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
- * E-mail:
| | - Muhammad J. Husain
- Keele Management School, Keele University, Keele, Newcastle, England, United Kingdom
| | - Sinead Brophy
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Helen Davies
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | | | - Mark D. Atkinson
- College of Medicine, Swansea University, Swansea, Wales, United Kingdom
| | - Ceri J. Phillips
- College of Human and Health Sciences, Swansea University, Swansea, Wales, United Kingdom
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland, United Kingdom
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Lyratzopoulos G, Vedsted P, Singh H. Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation. Br J Cancer 2015; 112 Suppl 1:S84-91. [PMID: 25734393 PMCID: PMC4385981 DOI: 10.1038/bjc.2015.47] [Citation(s) in RCA: 106] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The diagnosis of cancer is a complex, multi-step process. In this paper, we highlight factors involved in missed opportunities to diagnose cancer more promptly in symptomatic patients and discuss responsible mechanisms and potential strategies to shorten intervals from presentation to diagnosis. Missed opportunities are instances in which post-hoc judgement indicates that alternative decisions or actions could have led to more timely diagnosis. They can occur in any of the three phases of the diagnostic process (initial diagnostic assessment; diagnostic test performance and interpretation; and diagnostic follow-up and coordination) and can involve patient, doctor/care team, and health-care system factors, often in combination. In this perspective article, we consider epidemiological 'signals' suggestive of missed opportunities and draw on evidence from retrospective case reviews of cancer patient cohorts to summarise factors that contribute to missed opportunities. Multi-disciplinary research targeting such factors is important to shorten diagnostic intervals post presentation. Insights from the fields of organisational and cognitive psychology, human factors science and informatics can be extremely valuable in this emerging research agenda. We provide a conceptual foundation for the development of future interventions to minimise the occurrence of missed opportunities in cancer diagnosis, enriching current approaches that chiefly focus on clinical decision support or on widening access to investigations.
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Affiliation(s)
- G Lyratzopoulos
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
- Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
| | - P Vedsted
- Department of Public Health, Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Aarhus University, DK-Bartholins Allé, 8000 Aarhus, Denmark
| | - H Singh
- Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston TX 77030, US
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Stack RJ, Mallen CD, Deighton C, Kiely P, Shaw KL, Booth A, Kumar K, Thomas S, Rowan I, Horne R, Nightingale P, Herron-Marx S, Jinks C, Raza K. The development and initial validation of a questionnaire to measure help-seeking behaviour in patients with new onset rheumatoid arthritis. Health Expect 2014; 18:2340-55. [PMID: 24889289 DOI: 10.1111/hex.12203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early treatment for rheumatoid arthritis (RA) is vital. However, people often delay in seeking help at symptom onset. An assessment of the reasons behind patient delay is necessary to develop interventions to promote rapid consultation. OBJECTIVE Using a mixed methods design, we aimed to develop and test a questionnaire to assess the barriers to help seeking at RA onset. DESIGN Questionnaire items were extracted from previous qualitative studies. Fifteen people with a lived experience of arthritis participated in focus groups to enhance the questionnaire's face validity. The questionnaire was also reviewed by groups of multidisciplinary health-care professionals. A test-retest survey of 41 patients with newly presenting RA or unclassified arthritis assessed the questionnaire items' intraclass correlations. RESULTS During focus groups, participants rephrased questions, added questions and deleted items not relevant to the questionnaire's aims. Participants organized items into themes: early symptom experience, initial reactions to symptoms, self-management behaviours, causal beliefs, involvement of significant others, pre-diagnosis knowledge about RA, direct barriers to seeking help and relationship with GP. The test-retest survey identified seven items (out of 79) with low intraclass correlations which were removed from the final questionnaire. CONCLUSION The involvement of people with a lived experience of arthritis and multidisciplinary health-care professionals in the preliminary validation of the DELAY (delays in evaluating arthritis early) questionnaire has enriched its development. Preliminary assessment established its reliability. The DELAY questionnaire provides a tool for researchers to evaluate individual, cultural and health service barriers to help-seeking behaviour at RA onset.
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Affiliation(s)
- Rebecca J Stack
- Centre for Translational Inflammation Research, School of Infection and Immunity, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - Chris Deighton
- Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derby, UK
| | - Patrick Kiely
- Department of Rheumatology, St Georges Healthcare Trust, London, UK
| | - Karen L Shaw
- School of Health and Population Sciences, University of Birmingham, Birmingham, UK
| | - Alison Booth
- Department of Rheumatology, Derby Hospitals NHS Foundation Trust, Derby, UK
| | - Kanta Kumar
- Centre for Translational Inflammation Research, School of Infection and Immunity, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Susan Thomas
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Ian Rowan
- Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Rob Horne
- School of Pharmacy, University of London, London, UK
| | - Peter Nightingale
- Wolfson Computer Laboratory, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Sandy Herron-Marx
- Faculty of Health and Social Care, The Open University, Milton Keynes, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Keele University, Staffs, UK
| | | | - Karim Raza
- Centre for Translational Inflammation Research, School of Infection and Immunity, University of Birmingham, Birmingham, UK.,Department of Rheumatology, Sandwell & West Birmingham Hospitals NHS Trust, Birmingham, UK
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Sykes M, Doll H, Gaffney K. Comment on: 'Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry' by Sørensen et al. Ann Rheum Dis 2014; 73:e44. [PMID: 24709862 DOI: 10.1136/annrheumdis-2014-205589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Mark Sykes
- Department of Rheumatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Helen Doll
- Oxford Outcomes, ICON Commercialisation and Outcomes, Oxford, UK
| | - Karl Gaffney
- Department of Rheumatology, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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The use of anti-TNF therapy for ankylosing spondylitis in everyday rheumatology practice and the relationship to disease activity, work disability and diagnostic delay. Ir J Med Sci 2013; 183:579-84. [PMID: 24362820 DOI: 10.1007/s11845-013-1054-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Ankylosing spondylitis (AS) is characterised by insidious onset lower back pain. Poor symptom recognition results in delays in diagnosis of up to 11 years. Despite the widespread use of anti-tumour necrosis factor alpha (anti-TNFα) therapy, work disability remains a challenging problem in AS. METHODS A retrospective review of AS patients attending our physiotherapy service was carried out. Data regarding patient demographics, delay in diagnosis, treatment and disease activity were recorded. RESULTS Ninety-two patients were identified of which 80 % were male. Just over 60 % of patients were on treatment with a TNF inhibitor and the average delay in diagnosis was 6 years. Clinically relevant changes in disease activity after 3 months of anti-TNFα therapy were demonstrated with a reduction in Bath AS Metrology Index, Bath AS Functional Index and Bath AS Disease Activity Index of 1, 1.99 and 2.39, respectively. In patients under the age of 65 years only 55.4 % of patients were employed. There was no relationship identified between diagnostic delay, employment status and treatment with an anti-TNF agent. CONCLUSIONS Delays in diagnosis of AS remain unacceptably high; however, delays of 6 years compare favourably to reported data. Despite this and the appropriate use of anti-TNFα agents, we continue to see high rates of unemployment in this patient group which can impact both on the person and society and bears further consideration.
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Cooksey R, Brophy S, Husain MJ, Irvine E, Davies H, Siebert S. The information needs of people living with ankylosing spondylitis: a questionnaire survey. BMC Musculoskelet Disord 2012; 13:243. [PMID: 23227937 PMCID: PMC3553011 DOI: 10.1186/1471-2474-13-243] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 11/26/2012] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Today, health care is patient-centred with patients more involved in medical decision making and taking an active role in managing their disease. It is important that patients are appropriately informed about their condition and that their health care needs are met. We examine the information utilisation, sources and needs of people with ankylosing spondylitis (AS). METHODS Participants in an existing AS cohort study were asked to complete a postal or online questionnaire containing closed and open-ended questions, regarding their information access and needs. Participants were stratified by age and descriptive statistics were performed using STATA 11, while thematic analysis was performed on open-ended question narratives. Qualitative data was handled in Microsoft Access and explored for emerging themes and patterns of experiences. RESULTS Despite 73% of respondents having internet access, only 49% used the internet to access information regarding AS. Even then, this was only infrequently. Only 50% of respondents reported accessing written information about AS, which was obtained mainly in specialist clinics. Women were more likely than men to access information (63% (women) 46% (men)) regardless of the source, while younger patients were more likely to use online sources. The main source of non-written information was the rheumatologist. Overall, the respondents felt there was sufficient information available, but there was a perception that the tone was often too negative. The majority (95%) of people would like to receive a regular newsletter about AS, containing positive practical and local information. Suggestions were also made for more information about AS to be made available to non-specialist medical professionals and the general public. CONCLUSIONS There appears to be sufficient information available for people with AS in the UK and this is mostly accessed by younger AS patients. Many patients, particularly men, choose not to access AS information and concerns were raised about its negative tone. Patients still rely on written and verbal information from their specialists. Future initiatives should focus on the delivery of more positive information, targeting younger participants in particular and increasing the awareness in the general population and wider non-specialist medical community.
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Affiliation(s)
- Roxanne Cooksey
- College of Medicine, Swansea University, Swansea SA2 8PP, UK.
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Van Rossen L, Withrington RH. Improving the standard of care for people with ankylosing spondylitis and a new approach to developing specialist ESP-Led AS clinics. Musculoskeletal Care 2012; 10:171-177. [PMID: 22778011 DOI: 10.1002/msc.1015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES In the UK, there is a wide variation in the quality of care that people with ankylosing spondylitis (AS) receive. People with AS require early diagnosis and referral to a specialist team to commence treatment and optimize outcome. METHODS At East Kent Hospitals University Foundation Trust, a specialist clinic led by an extended scope practitioner (ESP) physiotherapist has been set up for the assessment and monitoring of patients with AS. This report describes the service provided by the AS clinic. RESULTS Over eight years, the number of patients seen has risen from 62 to 352, and annual consultations from 186 to 986, with an average of 2.8 visits per patient per year. Ninety-seven patients have started treatment with a Tumour Necrosis Factor (TNF) blocker. The service has expanded by the addition of a support worker and biologic clinics. CONCLUSION For the Trust, the specialist service provides an improved quality of care and cost-effective use of staff resources. Evaluation has demonstrated that patients welcome the new service.
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Affiliation(s)
- Liz Van Rossen
- East Kent Hospitals University Foundation Trust, Canterbury, UK.
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Current World Literature. Curr Opin Rheumatol 2012; 24:342-9. [DOI: 10.1097/bor.0b013e328352d26c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keat A, Gaffney K, Marzo-Ortega H, Cornell T, MacKay K, Skerrett J, Van Rossen L, Wordsworth BP. Improving the treatment of ankylosing spondylitis in the UK. Rheumatology (Oxford) 2011; 50:1936-9. [DOI: 10.1093/rheumatology/ker075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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