The ASAS group has defined a set of classification criteria to distinguish between inflammatory back pain and back pain from other causes1
IBP parameters1
AxSPEN
Screening Tool
AxSPEN (Axial SPondyloarthritis Early diagNosis)
Rheumatologic referral screening tool for healthcare providers with patients that have chronic back pain
AxSPEN SCREENING TOOL
Guide for the tool
- This interactive tool provides a referral strategy to see if patients with chronic back pain should be referred to a rheumatologist to investigate axial spondyloarthritis (axSpA) as a potential cause of their symptoms
- It is not intended to be used for clinical assessment or diagnosis
Instructions
- Select START SCREENING to begin screening questionnaire
- Review screening questions for your patient
- Click the appropriate response for your patient on each screen
- Review the recommendation provided regarding rheumatologic referral with your patient
- Select START OVER to screen again
- Access additional educational resources by selecting the RESOURCES button
AxSPEN SCREENING TOOL
Does your patient have1,2:
-
Back pain and symptom duration lasting
>3 months
AND -
Onset of back pain before 45 years of age
AND - No prior confirmed diagnosis of AS or axSpA?
AxSPEN SCREENING TOOL
Does your patient have at least one of the following?1,2:
- Inflammatory back pain
- HLA-B27 blood test positivity
- Sacroiliitis detected by imaging
Chronic back pain is the dominant symptom in patients with axSpA1,2
Age at onset:<40 years
Insidious onset
Improvement with exercise
No improvement with rest
Pain at night (with improvement upon getting up)
The presence of at least four of these features suggest IBP1,*
HLA-B27 is an important biomarker used in the diagnosis and classification of SpA1,2
HLA-B27 antigen:
- Is found in 74% to 89% of patients with axSpA3
- Is a sensitive and specific test for SpA in the Caucasian population1,*
- There are geographic differences in both the background population prevalence and the strength of association of HLA-B27 with axSpA1
Disease onset is approximately 5 years earlier in HLA-B27–positive patients compared to HLA-B27–negative patients4
SIJ imaging is essential for assessment of axSpA1,2
- Recommended initial imaging modality is an X-ray of the SIJ for the presence of definite radiographic sacroiliitis1,a
- If there is no evidence of radiographic
sacroiliitis despite clinical suspicion of
axSpA, then an MRI of the SIJ
is considered1,2
- MRI can detect active inflammatory changes, such as osteitis and BME, before structural damage can be assessed on radiographs1
AxSPEN SCREENING TOOL
Referral to a Rheumatologist
may not be warranted at
this time.
Continue to evaluate for nonrheumatologic
causes of chronic back pain.
Global prevalence of axSpA is comparable to that of rheumatoid arthritis1
Global prevalence of axSpA1: 0.5% to 1.5%
- US prevalence of axSpA1: 1.4%
- US prevalence of AS1,2: 0.2% to 0.55%
Gender ratio in prevalence rates1,3
- For patients with AS, male-to-female ratio is 2-3:1
- For patients with non-radiographic axSpA, male-to-female ratio is 1:1
Back pain and morning stiffness are the leading symptoms in patients with axSpA1
Patients typically present with2:
- IBP
- Stiffness of the pelvis and lower back
- Morning stiffness in the spine
- Back pain in the second half of the night
- Restricted spinal mobility
Peripheral and extra-articular manifestations may include2:
- Arthritis and enthesitis, predominantly in lower limbs asymmetrically
- Inflammatory bowel disease
- Uveitis
- Dactylitis
- Psoriasis
There is a considerable diagnostic delay for patients with axSpA1,2
- In the US, diagnostic delay between symptom onset and diagnosis of axSpA can be up to 13 years3
- Diagnostic challenges include slow development of radiographic changes, high number of patients with chronic back pain, and lack of specific examinations and biomarkers2,3
- Delayed diagnosis contributes to burden of disease for patients with axSpA and their caregivers4,5
- Early diagnosis and management of axSpA may decrease disease burden in patients with axSpA and increase their QoL3,5
Women with back pain experience longer time to rheumatologist referral1
- Underrecognition of axSpA in women may be due to misperception that axSpA is predominantly in men1,2
- Clinical manifestation of axSpA is also different in women, which may contribute to delayed diagnosis2
- As a result, women with axSpA experience increased burden of disease due to delays in diagnosis and management2
Compared to men, women with axSpA present with2:
- Lower frequency of IBP
- More prominent upper thoracic and neck or widespread pain
- Less severe or slower progression of radiographic damage
AxSPEN RESOURCES
axSpA is a chronic inflammatory disease of the axial skeleton1
There are two forms of axSpA2
-
Non-radiographic axSpA1:
- Considered earlier form of axSpA
- No structural damage in the SIJ visible on a radiograph
- Structural damage in the axial skeleton may develop, which can take years
-
Ankylosing spondylitis (AS)1:
- Also known as radiographic axSpA
- Radiographic evidence of structural damage in the SIJ
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