897 van Onna, et al: GP recognition of axSpA Personal non-commercial use only. The Journal of Rheumatology Copyright © 2014. All rights reserved. General Practitioners’ Perceptions of Their Ability to Identify and Refer Patients with Suspected Axial Spondyloarthritis: A Qualitative Study Marloes van Onna, Simone Gorter, Aniek van Meerendonk, and Astrid van Tubergen ABSTRACT. Objective. To explore the knowledge, beliefs, and experiences of general practitioners (GP) about inflammatory back pain (IBP) and axial spondyloarthritis (axSpA) and potential barriers for referral of patients suspected of having axSpA. Methods. A qualitative study involving semistructured interviews with GP was conducted. Transcripts of the interviews were independently read and annotated by 2 readers. Illustrative themes were identified and a coding system to categorize the data was developed. Results. Ten GP (all men; mean age 49 yrs) were interviewed. All could adequately describe “classic” ankylosing spondylitis (AS) and mentioned chronic back pain and/or stiffness as key features. All GP thought that AS is almost exclusively diagnosed in men. Six GP knew that there is a difference between mechanical back pain and IBP, but could recall only a limited number of variables indicative of IBP, such as awakening night pain (4 GP), insidious onset of back pain (1 GP), improvement with movement (1 GP), and (morning) stiffness (2 GP). Two GP mentioned peripheral arthritis as other SpA features, none mentioned dactylitis or enthesitis. GP awareness of associated extraarticular manifestations was low. Most GP expressed that (practical) referral measures would be useful. Conclusion. GP are aware of “classic”, but longterm features of axSpA. Knowledge about the disease spectrum and early detection is, however, limited. Addressing these issues in training programs may improve recognition of axSpA in primary care. This may ultimately contribute to earlier referral, diagnosis, and initiation of effective treatment in patients with axSpA. (First Release April 1 2014; J Rheumatol 2014;41:897–901; doi:10.3899/jrheum.131293) Key Indexing Terms: INFLAMMATORY BACK PAIN AXIAL SPONDYLOARTHRITIS PRIMARY CARE From the Department of Medicine, Division of Rheumatology, Maastricht University Medical Center; The School for Public Health and Primary Care (CAPHRI), University of Maastricht, Maastricht, The Netherlands. A goodwill donation for the interviews with the general practitioners was provided by Abbvie. M. van Onna, MD; S. Gorter, MD, PhD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center and CAPHRI, University of Maastricht; A. van Meerendonk, MD, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center; A. van Tubergen, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center and CAPHRI, University of Maastricht. Address correspondence to Dr. M. van Onna, Department of Medicine, Division of Rheumatology, Maastricht University Medical Center and School for Public Health and Primary Care (CAPHRI), University of Maastricht, P. Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. E-mail: m.van.onna@mumc.nl Accepted for publication January 21, 2014. Spondyloarthritis (SpA) comprises a group of interrelated inflammatory disorders with overlapping clinical features and shared genetic markers. The estimated prevalence of SpA in white populations is about 1%, similar to that of rheumatoid arthritis 1 . Symptom patterns and physical signs of SpA can be divided into predominantly axial involve- ment, with inflammatory back pain (IBP) as the most important clinical feature and predominantly peripheral involvement including peripheral arthritis, dactylitis, and enthesitis 2 . Extraarticular manifestations related to axial and peripheral SpA include psoriasis, anterior uveitis, and inflammatory bowel disease. Axial SpA (axSpA) comprises a disease continuum, including both nonradiographic axSpA and ankylosing spondylitis (AS) 3 . Patients with nonradiographic axSpA have similar clinical characteristics, disease activity, and response to treatment as patients with established AS, emphasizing the need for early and correct diagnosis 4 . However, the diagnosis of axSpA is often delayed owing to the insidious onset, the heterogeneous clinical picture, and a limited knowledge about the manifestations belonging to axSpA by general practitioners (GP) or other referring physi- cians 5 . Offering tools for referral may be helpful in improving early diagnosis. Several initiatives have been performed to study the effect of referral strategies in primary care. The objectives of these referral programs were to identify patients with possible axSpA early, to make a correct diagnosis, and to provide the best possible care as early as possible 6 . However, limited knowledge of manifestations belonging to axSpA might prevent successful implemen- tation of these referral strategies in the primary care setting. www.jrheum.org Downloaded on March 12, 2022 from