Evidence-based recommendations for the diagnosis of ankylosing spondylitis: Results from the Australian 3E initiative in rheumatology

Kain, T., Zochling, J., Taylor, A., Manolios, N., Smith, M. D., Reed, M. D., Brown, Matthew A., & Schachna, L. (2008) Evidence-based recommendations for the diagnosis of ankylosing spondylitis: Results from the Australian 3E initiative in rheumatology. Medical Journal of Australia, 188(4), pp. 235-237.

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Abstract

• As part of the 3E program, we conducted a systematic literature review and gathered consensus from 23 practising Australian rheumatologists to develop guidelines for early identification of ankylosing spondylitis and specialist referral. • In three rounds of break-out sessions followed by discussion and voting, the specialist panel addressed three questions related to diagnosis of ankylosing spondylitis: In individuals with back pain, what are the early clinical features that suggest ankylosing spondylitis? How useful is imaging in identifying early ankylosing spondylitis? Based on which clinical features should a general practitioner refer a patient to a rheumatologist for further evaluation? • The panel agreed on six recommendations related to the three questions: 1a. Early clinical features to suggest ankylosing spondylitis include inflammatory back pain and age at symptom onset < 45 years. 1b. The absence of symptomatic response to an appropriate course of non-steroidal anti-inflammatory drugs makes the diagnosis of ankylosing spondylitis less likely. 1c. Raised inflammatory markers are supportive, but their absence does not rule out the diagnosis of ankylosing spondylitis. 2a. Despite low sensitivity to detect changes of early ankylosing spondylitis, plain radiographs of the pelvis and spine are appropriate initial imaging techniques. 2b. Magnetic resonance imaging is a useful imaging modality for detecting early changes of ankylosing spondylitis. 3. Individuals with inflammatory back pain should be referred to a rheumatologist for further evaluation. • Effective dissemination and implementation of these recommendations are important to standardise the approach to early diagnosis of ankylosing spondylitis.

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ID Code: 89416
Item Type: Journal Article
Refereed: Yes
Keywords: C reactive protein, nonsteroid antiinflammatory agent, ankylosing spondylitis, article, Australia, backache, chronic pain, clinical feature, consensus development, early diagnosis, erythrocyte sedimentation rate, evidence based medicine, human, information dissemination, nuclear magnetic resonance imaging, patient referral, pelvis radiography, practice guideline, sensitivity and specificity, conference paper, Evidence-Based Medicine, Humans, Spondylitis, Ankylosing
ISSN: 0025-729X
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2008 Australasian Medical Publishing Company Pty. Ltd.
Deposited On: 23 Oct 2015 02:16
Last Modified: 22 Aug 2016 02:18

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