Recommendation ID

Referral criteria for people with suspected axial spondyloarthritis:- What are the optimal referral criteria for people with suspected axial spondyloarthritis?

Any explanatory notes
(if applicable)

Why this is important:- The Dutch CaFaSpA study (van Hoeven et al. 2014, 2015) should be repeated in a UK population. This would involve examining GP databases to identify a cohort of people who have a diagnosis of non-specific back pain who first consulted their GP for back symptoms under the age of 45. These people would be invited for a full rheumatological assessment (including identifying signs and symptoms relevant to axial spondyloarthritis, X-ray, MRI and HLA-B27 test). All participants would be given a reference-standard diagnosis of axial spondyloarthritis or not (ideally using expert clinician opinion, or if this is not possible, using the ASAS [Assessment of Spondyloarthritis International Society] classification criteria). The cohort would be split into a development and validation set, to derive and validate optimal rules for case-finding from the available data, with each candidate strategy judged according to expected cost per quality-adjusted life year (QALY) gained (the NICE economic model developed for this guideline could easily be used to estimate these).
As a result of the large number of permutations of possible referral strategies, it is impractical to run separate validation studies for all referral criteria that are developed. Therefore, a single large, representative cohort study would, provided it measured the predictor variables for all reasonable referral strategies, provide the ability to develop and validate any number of possible referral strategies. The study would need to be large enough that sufficient data are available to derive new referral rules and to validate those rules in a separate, independent subset of the data. A UK-specific dataset would provide more relevant data to do this than is currently available from the Dutch CaFaSpA study. For example, that study found an HLA-B27 prevalence of 20% in people with axial spondyloarthritis and 2% in people without; much lower than the estimates found elsewhere (75% and 20% respectively). This lowers the validity of extrapolating any results found to the UK, and reinforces the need for UK-specific data to address this question.

Source guidance details

Comes from guidance
Spondyloarthritis in over 16s: diagnosis and management
Date issued
February 2017

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 28/02/2017