Reumatol Clin. 2015;11(2):90–98 ww w . r eumatologiaclinica.org Original Article Reccomendations for the Detection, Study and Referral of Inflammatory Low-back Pain in Primary Care  Xavier Juanola Roura, a,b,c Eduardo Collantes Estévez, d,e,f,c Fernando León Vázquez, g Antonio Torres Villamor, h María Jesús García Yébenes, i Rubén Queiro Silva, j,c Jordi Gratacós Masmitja, k,c Emilio García Criado, l,m Sergio Giménez, n,m Loreto Carmona i,∗ , Study Group for Inflammatory Back Pain 1 a Servicio de Reumatología, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain b Institut d’Investigació Biomédica de Bellvitge, Barcelona, Spain c Grupo de Estudio de las Espondiloartritis de la SER d Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain e Servicio de Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain f Universidad de Córdoba, Córdoba, Spain g Centro de Salud Universitario San Juan de la Cruz, Pozuelo de Alarcón, Madrid, Spain h Centro de Salud Arroyo de la Media Legua, Servicio Madrile˜ no de Salud, Madrid, Spain i Instituto de Salud Musculoesquelética, Madrid, Spain j Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain k Hospital Parc Taulí, Sabadell, Barcelona, Spain l Unidad de Gestión Clínica Fuensanta, Córdoba, Spain m Sociedad Espa˜ nola de Médicos de Atención Primaria (SEMERGEN-AP) n Unidad de Gestión Clínica Limonar, Málaga, Spain a r t i c l e i n f o Article history: Received 10 January 2014 Accepted 14 April 2014 Available online 23 October 2014 Keywords: Inflammatory back pain Referral Primary care Recommendations Guidelines Spondyloarthritis a b s t r a c t Objective: To design a strategy for the early detection and referral of patients with possible spondy- loarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. Methods: We used a modified RAND/UCLA methodology plus a systematic literature review. The infor- mation was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. Results: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years could be performed in four phases (1) clinical: key questions, (2) clinical: extra questions, (3) physical examination, and (4) additional tests. Conclusions: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments. © 2014 Elsevier Espa ˜ na, S.L.U. All rights reserved.  Please cite this article as: Juanola Roura X, Collantes Estévez E, León Vázquez F, Torres Villamor A, García Yébenes MJ, Queiro Silva R, et al. Recomendaciones para la detección, investigación y derivación del dolor lumbar inflamatorio en Atención Primaria. Reumatol Clin. 2015;11:90–98. ∗ Corresponding author. E-mail address: loreto.carmona@inmusc.eu (L. Carmona). 1 The names of the components of the Study Group for Inflammatory Back Pain presented in Annex 1. 2173-5743/© 2014 Elsevier Espa ˜ na, S.L.U. All rights reserved. Document downloaded from http://www.elsevier.es, day 05/04/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited. Document downloaded from http://www.elsevier.es, day 05/04/2018. This copy is for personal use. Any transmission of this document by any media or format is strictly prohibited.