Guidelines from the Spondyloarthritis Research and Treatment Network on Referring Adults with Chronic Back Pain for Suspected Axial Spondyloarthritis Evaluation by Rheumatologists

To develop evidence-based referral recommendations for adults with chronic back pain at risk for axial spondyloarthritis (axSpA) to rheumatologists.

Methodology Development: The project involved a steering committee, a literature review committee, and a broader contributor group, utilizing systematic reviews, Delphi methods, and discrete choice experiments.
Systematic Review and Meta-Analysis: A systematic review was conducted to identify features predictive of axSpA diagnosis among patients with chronic back pain.

AxSpA affects more than 1% of U.S. adults and is often misdiagnosed, leading to significant delays in treatment.
The mean diagnostic delay for axSpA is reported to be six to eight years, compared to four months for rheumatoid arthritis.
The referral approach aims to increase the probability of axSpA diagnosis among referred individuals to approximately 33%.

The guidelines represent the first data-driven referral recommendations in North America for suspected axSpA in adults with chronic back pain.

Prospective validation of the referral approach is necessary to confirm its effectiveness in real-world practice.
The guidelines may not be directly transferable to other healthcare systems outside North America.

The SPARTAN guidelines aim to improve the timely diagnosis and management of axSpA in adults with chronic back pain.