FRI0554 Young Patients with Back Pain and Maximally 1 Spondyloarthritis Feature: Is it Necessary to Test HLA-B27 or Image the Sacroiliac Joints?. (9th June 2015)

• Record Type: Journal Article
• Authors: Bakker, P.; Ez-Zaitouni, Z.; van Lunteren, M.; van den Berg, R.; de Hooge, M.; Berg, I.; Landewé, R.; van Oosterhout, M.; Ramonda, R.; Huizinga, T.; Reijnierse, M.; van Gaalen, F.; van der Heijde, D.
• Is Part Of: Annals of the rheumatic diseases. Volume 74(2015)Supplement 2
• Page Start: 628
• Page End: 628
• Publication Date: 2015-06-09
• Subjects: Rheumatism -- Periodicals; 616.723005
• DOI: 10.1136/annrheumdis-2015-eular.4691
• Languages: English
• ISSNs: 0003-4967

Abstract

Abstract : Background: Axial SpondyloArthritis (axSpA) is a heterogeneous disease. The likelihood of diagnosis varies depending upon the presence of the specific SpA-features. It is debated whether additional examinations (i.e. HLA-B27 testing and imaging of the sacroiliac joints (SIJ)) should be performed in patients with a low suspicion of axSpA (0-1 present SpA-features) after clinical examination, physical examination, CRP/ESR measurement. Objectives: To investigate if HLA-B27 testing and imaging of the SIJ is useful in young patients with back pain and maximally 1 SpA feature. Methods: The SPACE cohort includes patients with chronic back pain (CBP; ≥3 months ≤2 years, onset <45 years) recruited from 5 participating centres across Europe. All patients underwent full diagnostic work-up: MRI and x-rays SIJ, HLA-B27 testing and assessment of all other SpA-features. Patients were classified according to the ASAS axSpA-criteria and according to the clinical rheumatologist diagnosis. Results: In this analysis, 133 patients were included. Of the 38/133 (28.6%) patients without SpA-features; 4/38 (10.5%) were classified according to the ASAS-axSpA criteria after additional investigations (table ). Three of them were also diagnosed as axSpA by the rheumatologist. Four additional patients were diagnosed axSpA but did not fulfil the ASAS axSpA criteria. Of the 95/133 (71.4%) patients with 1 SpA-feature; 22/95 (23.2%) patients fulfilled the ASAS criteria via the imaging arm. SpA features in these patients were: 7 IBP, 5 IBD, 4 positive family history for SpA, 3 good response to NSAIDs, 2 raised CRP/ESR, 1 enthesitis. Seventeen of these 22 patients were also diagnosed as axSpA by the rheumatologist. Six additional patients were diagnosed axSpA but did not fulfil the ASAS axSpA criteria. Conclusions: In patients with CBP and maximally 1 SpA feature after medical history, physical examination and CRP/ESR measurement, subsequent HLA-B27 testing and imaging led to fulfilment of the ASAS axSpA-criteria in 11% and 23%, respectively. In addition axSpA was the clinical diagnosis in almost twenty percent of this group. Therefore, in patients with maximally 1 SpA feature, axSpA cannot be ruled out without additional imaging and/or HLA-B27 testing. Disclosure of Interest: None declared