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Ankylosing spondylitis – are you spotting it early enough?

Issue 25 Synovium (Autumn 2008)

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A survey of 300 GPs in Norfolk1 identified inconsistencies in their perceptions of and approach to the diagnosis and management of ankylosing spondylitis (AS). So why is this important? Well, effective treatment with anti-TNF medication is now available. Treatment is most effective if given in the first 10 years of the disease. Unfortunately the average duration of symptoms at diagnosis is around 7 years – reducing the opportunity for early treatment significantly.2 Improving the recognition of inflammatory back pain (IBP) presentation in primary care might lead to earlier referral to specialist rheumatology services and hence earlier diagnosis and treatment for patients with AS. The survey tested GPs’ ability to recognise 8 clinical features suggestive of IBP:

  • insidious onset
  • duration >3 months
  • back pain relieved by exercise
  • back pain not relieved by rest
  • morning stiffness >30 minutes
  • nocturnal pain
  • alternating buttock pain
  • good response to anti-inflammatory drugs.

They were also asked about their perceptions of the usefulness of a positive family history, HLA-B27 status, inflammatory markers (ESR/CRP), spinal x-ray and physiotherapy in patients with suspected IBP. Finally the questionnaire asked about unmet needs with respect to IBP and care of patients with AS. Sparing the detail, the results from 186 (62%) returned questionnaires were disappointing, with poor recognition of the clinical features of IBP. There were patchy perceptions with respect to the utility of family history, HLA-B27, ESR/CRP, imaging and physiotherapy. Unmet needs were described in free text. Timely access to physiotherapy was most frequently mentioned. Other needs included how to differentiate inflammatory from mechanical back pain and access to diagnostic and specialist treatment services. The authors concluded that ‘Education in primary care and the wider use of diagnostic algorithms may improve the early detection and hence outcome of AS in the UK’. So we are playing our part by bringing the findings to a wider audience.

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