Objective Chronic inflammatory back pain (IBP) is frequently reported in axial SpA (axSpA) but also in the general population. We evaluated a recently proposed two-step referral system for early recognition of axSpA in primary care and compare it with other combinations of symptoms and SpA-related items. Methods Consecutive chronic back pain patients ≤45 years of age answered a questionnaire and were seen by a primary care physician who decided whether HLA-B27 needed to be determined. They were then referred to a rheumatologist who made the diagnosis. Generally sticking to the two-step system with HLA-B27 as an additional option, combinations with a sensitivity ≥90% and a likelihood ratio >4 were compared. Results A total of 326 patients were included, 46 of whom were diagnosed with axSpA (14.1%). The sensitivity of the strategy was 87%, the specificity was 56.8% and the positive and negative predictive values were 24.8% and 96.4%, respectively. A ‘good response to NSAIDs’, ‘morning stiffness >30 min’ and ‘elevated C-reactive protein’ performed best, with a sensitivity of 91%, specificity of 67%, positive predictive value of 31% and negative predictive value of 98%. On that basis, only three patients had to be seen by a rheumatologist to diagnose one. Conclusion The earlier proposed referral system worked well but was outperformed by other combinations with high sensitivity and better specificity, which deserve to be prospectively studied.
Objective To investigate the performance of a health app with respect to usability, adherence and equivalence of data in daily care of patients with axial spondyloarthritis (axSpA). Methods Consecutive axSpA patients were asked to export patient-reported outcomes (PRO) electronically with the AxSpA Live App regularly every 2 weeks over a period of 6 months. The first clinical visit was followed by two further personal visits after 3 and 6 months. Patients completed paper-based PRO at every visit, and the Mobile App Rating Scale (MARS) and the System Usability Scale (SUS) after 3 and 6 months, respectively. Results Of 103 axSpA patients 69 agreed to participate (67.0%): age 41.5 (11.3) years, 58.0% male, BASDAI 4.3 (2.0), and 76.8% treated with biologic DMARDS. Patients' adherence to regular app exports was 29.0% and 28.6% after 3 and 6 months, respectively. Significant predictors for good adherence were high disease activity (p = 0.02) and older age (p = 0.04). No systematic differences between digital and paper-based BASDAI scores were found (ICC 0.99 (95%CI 0.98 – 0.99). Performance of the app was rated as good. Conclusion Collection of digital PROs by use of AxSpA Live App may be successfully used in axSpA patients with high disease activity. Our study showed equivalence of digital data but the adherence to the app after 6 months was poor. Higher disease activity and older age resulted in increased adherence to the app. This suggests that the use of health apps like this should concentrate on more severely affected patients.
BackgroundThe crystal-induced calcium pyrophosphate deposition disease (CPPD) clinically appearing as pseudogout differs from the mere radiographic finding of chondrocalcinosis (CC) but may cause symptoms resembling rheumatoid arthritis (RA).ObjectiveTo study the prevalence of CPPD and CC in rheumatic diseases focusing on differences between seropositive and seronegative RA.Patients and methodsIn a retrospective study design, we analysed records and radiographs of consecutive new patients presenting to our centre between January 2017 and May 2020. 503 patients were identified based on expert diagnoses: 181 with CPPD, 262 with RA, 142 seropositive (54.2%) and 120 seronegative RA, gout (n=30) and polymyalgia rheumatica (n=30), mean symptom duration <1 year in almost all patients.ResultsThe majority of patients had only one rheumatological diagnosis (86.9%). Most patients with CPPD (92.6%) had radiographic CC, primarily in the wrists. The prevalence of CC was higher in seronegative (32.3%) than in seropositive RA (16.6%), respectively (p<0.001). Patients with CPPD were older (p<0.001) and had acute attacks more frequently than patients with RA (p<0.001), who had symmetric arthritis more often (p=0.007). The distribution pattern of osteoarthritic changes in radiographs of hands and wrists differs between patients with RA and CPPD. CC was present in more than one joint in 73.3% of patients with CPPD, 9.6% with seropositive and 18.7% with seronegative RA.DiscussionCPPD and CC were more frequent in seronegative versus seropositive RA. Symmetry of arthritis and acuteness of attacks differentiated best between CPPD and RA but localisation of joint involvement did not. Co-occurrence of both diseases was frequently observed.
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