CHAPTER 8: Strategies for the diagnosis of patients with axial spondyloarthritis
Abstract
It is known that the most relevant clinical manifestation in axial spondyloarthritis (axSpA) is chronic low back pain, especially when it begins at an early age (before 40 years) and has inflammatory characteristics. The prevalence of chronic low back pain in the general population can reach 20%, depending on the age range and the region where it is detected, being lower in Latin American populations, especially in indigenous peoples where it can be present between 11-19%. In a retrospective analysis of German and Austrian cohorts in 2000, a 9-year delay in diagnosis was found. Despite the efforts made to reduce it by developing new classification criteria and the advent of new complementary tools, although the time was initially reduced by half, the delay remained stable in the last decade. This delay depends mainly on the age of onset of low back pain (longer in younger patients), gender (longer in women) and the presence or absence of HLA-B27 (longer in HLA-B27-negative patients). When analyzing the factors associated with the referral of patients with a subsequent diagnosis of ankylosing spondylitis (AS), the main health agent involved is the rheumatologist, although primary care physicians play a preponderant role. In a study conducted in the United States, younger patients, males, diagnosed with uveitis and those referred by the primary care physician were associated with more diagnoses of AS. In this sense, physical therapists could also play a preponderant role in the detection of young patients with low back pain refractory to physical therapy.References
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