Performance delle referral strategies per pazienti con sospetta spondiloartrite assiale: una revisione sistematica

Scritto da

DanielFeller

in

Performance of referral strategies for patients with suspected axial spondyloarthritis: a systematic review

Autori

Feller Daniel (Azienda Provinciale per i Servizi Sanitari, Trento, Italia; Erasmus Medical Center, Rotterdam, The Netherlands)

Wingbermühle Roel (Erasmus Medical Center, Rotterdam, The Netherlands)

Koes Bart (Erasmus Medical Center, Rotterdam, The Netherlands)

Ramiro Sofia (Leiden University Medical Center, Leiden, The Netherlands)

Chiarotto Alessandro (Erasmus Medical Center, Rotterdam, The Netherlands)

Background and aims

Axial spondyloarthritis (axSpA) is a chronic inflammatory condition often misdiagnosed as non-specific low back pain, leading to diagnostic delays averaging 6.7 years. Early referral to rheumatology is essential to initiate timely treatment and prevent structural damage. Various referral strategies have been proposed to assist non-specialists in identifying patients with suspected axSpA. However, the diagnostic performance of these strategies has not been comprehensively assessed since the 2012 ASAS review, which lacked methodological rigor. This systematic review aims to evaluate the diagnostic accuracy of referral strategies—defined as diagnostic tests or models—for identifying patients suspected of having axSpA.

Methods

We conducted a systematic review following a protocol registered on PROSPERO (CRD42025634153). We systematically searched MEDLINE, Embase, and CINAHL, with additional backward and forward citation tracking using Web of Science. No restrictions were placed on language or publication year. Two reviewers independently screened titles, abstracts, and full texts using Covidence, resolving disagreements via consensus or a third reviewer. Eligible studies included cross-sectional, cohort, and case-control designs that assessed referral strategies in adults with chronic (>3 months) low back pain. Data extraction will follow the CHARMS checklist for diagnostic models and included sensitivity, specificity, likelihood ratios, and AUC. Risk of bias will be assessed using QUADAS-2 (for diagnostic tests) and PROBAST (for diagnostic models). Meta-analysis or narrative synthesis will be conducted depending on heterogeneity, with evidence quality assessed using GRADE-based approaches adapted for diagnostic accuracy and prediction models.

Results

Following duplicate removal and screening, we included 21 studies evaluating the diagnostic performance of referral strategies for axSpA. These studies span various healthcare settings and geographic regions, and assess both test-based criteria (e.g., Berlin criteria) and multivariable prediction models. Data extraction and risk-of-bias assessment are currently ongoing. The final analysis, including meta-analyses and subgroup assessments, will be completed by August 2025.

Conclusion

This systematic review will provide updated evidence on the diagnostic accuracy of referral strategies for axSpA, supporting clinicians and policymakers in choosing appropriate tools for early identification. Findings aim to reduce diagnostic delays and improve patient outcomes through optimized referral practices.

REFERENCES

  1. Navarro-Compán V, Sepriano A, El-Zorkany B, van der Heijde D. Axial spondyloarthritis. Ann Rheum Dis. 2021 Dec;80(12):1511-1521. doi: 10.1136/annrheumdis-2021-221035. Epub 2021 Oct 6. PMID: 34615639.
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