Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond

Liew, David; Dau, Jonathan; Robinson, Philip C

doi:10.1007/s11926-021-01003-z

Cited by 6 publications

(2 citation statements)

References 96 publications

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“…However, in the European White population, HLA-B27 has a high positive likelihood ratio of 9.0 for the diagnosis of axSpA [49]. Therefore, it was incorporated in several referral strategies [50][51][52] because it is easy to prescribe, clear to interpret, and has a moderate one-time cost. Globally, in a target population consisting of patients with chronic low back pain and onset before 45 years of age, when a patient is referred to the rheumatologist based on HLA-B27 positivity and inflammatory back pain, the probability of having an axSpA diagnosis is about 60%.…”

Section: Human Leucocyte Antigen-b27 and Spondyloarthritis Classifica...mentioning

confidence: 99%

Human leucocyte antigen-B27 testing in clinical practice: a global perspective

Ziadé

2023

Current Opinion in Rheumatology

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Purpose of reviewThe association between human leucocyte antigen (HLA)-B27 and spondyloarthritis (SpA) was described half a century ago. New insights about pathophysiologic pathways and their role in bone formation were reported in recent years and will be discussed in this review. Recent findingsThere is a considerable variation in the association between HLA-B27 and SpA across the globe, with the strongest association reported in populations of Northern European and Asian descent and the lowest in the Middle East and Africa. Other genes are also involved in disease susceptibility, highlighting the importance of newly proposed weighted genetic scores to support the diagnosis. On the global level, the interaction between genetic background and gut dysbiosis seems critical for disease predisposition. As for the individual patient, the presence of HLA-B27 can have a significant influence on SpA diagnosis and disease phenotype. More importantly, new studies suggested a role for HLA-B27 in radiographic damage in the sacroiliac joints and the progression of bone formation in the spine. SummaryFindings in recent years have enhanced our understanding of the role of HLA-B27 in the pathophysiology and in disease-related bone formation in SpA, which may pave the way for new therapeutic targets.

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Section: Human Leucocyte Antigen-b27 and Spondyloarthritis Classifica...mentioning

confidence: 99%

Human leucocyte antigen-B27 testing in clinical practice: a global perspective

Ziadé

2023

Current Opinion in Rheumatology

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“…While some variation is expected, as patient and clinician tolerance of risk will vary in specific clinical situations [ 3 ], the optimal balance for patients in general is uncertain. It would be useful to determine what represents excessively frequent monitoring, as such low-value care might not only squander limited healthcare resources, but also cause patient anxiety [ 9 ]. Excessively frequent monitoring might also result in unwarranted changes to therapy or trigger unnecessary investigations [ 10 ], while insufficiently frequent monitoring may cause a delay in detecting clinically relevant abnormalities.…”

Section: Introductionmentioning

confidence: 99%

Attitudes and practices in the laboratory monitoring of conventional synthetic disease modifying anti-rheumatic drugs by rheumatologists and rheumatology trainees

et al. 2022

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Objectives There is scant research about laboratory monitoring in people taking conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) for rheumatic disease. Our objective was to conduct a scoping study to assess the range of current attitudes and the variation in practice of laboratory monitoring of csDMARDs by rheumatologists and trainees. Methods Australian and overseas rheumatologists or trainees were invited through newsletter, Twitter and personal e-mail, to complete an anonymous online survey between 1 February and 22 March 2021. Questions focused on laboratory tests requested by csDMARD prescribed, frequency/pattern of monitoring, influence of additional factors and combination therapy, actions in response to abnormal tests, and attitudes to monitoring frequencies. Results were presented descriptively and analysed using linear and logistic regression. Results There were 221 valid responses. Most respondents were from Australia (n = 53, 35%) followed by the US (n = 39, 26%), with a slight preponderance of women (n = 84, 56%), ≥ 11 years in rheumatology practice (n = 83, 56%) and in mostly public practice (n = 79, 53%). Respondents had a wide variation in the frequency and scheduling of tests. In general, respondents reported increasing monitoring frequency if patients had numerous comorbidities or if both methotrexate and leflunomide were being taken concurrently. There was a wide variety of responses to abnormal monitoring results and 27 (40%) considered that in general, monitoring tests are performed too frequently. Conclusions The results demonstrated a wide variation in the frequency of testing, factors that should influence this, and what responses to abnormal test results are appropriate, indicates a likely lack of evidence and the need to define the risks, benefits and costs of different csDMARD monitoring regimens.

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