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Background: There is limited prospective data as to the frequency of axial spondyloarthritis (axSpA) in unselected patients referred to rheumatologists with undiagnosed back pain. It is also unclear which clinical features discriminate between axSpA and non-specific causes of back pain that might inform the development of a screening strategy. Objectives: To determine the prevalence of axSpA in unselected patients referred with undiagnosed back pain presenting with AAU, psoriasis, or colitis and determine which clinical characteristics define patients with axSpA. Methods: The multicenter Screening for Axial Spondyloarthritis in Psoriasis, Iritis, and Colitis (SASPIC) Study is aimed at facilitating early detection of axial SpA. First and last patients were recruited on February 2013 and March 2018, respectively. Consecutive patients ≤45 years of age with ≥3 months undiagnosed back pain with any one of psoriasis, AAU, or colitis had routine clinical evaluation by a rheumatologist for axial SpA and MRI evaluation ordered per rheumatologist decision. Differences in clinical characteristics between those who were diagnosed as axSpA or non-specific back pain were analyzed using chi-squared and t-tests. Results: A total of 246 patients were recruited, 47.6% were diagnosed with axSpA, and these included 68.5% of B27 positive patients (Table 1). Diagnosis of axSpA was established in 45.7%, 61.6%, and 40.2% of patients, while ASAS classification criteria were met by 26.1%, 71.2%, and 27.6% of patients with psoriasis, AAU, and IBD, respectively. Features of inflammatory back pain, male gender, and B27 positivity, but not physical measures discriminated axSpA from other causes of back pain (Table 2). Conclusion: Patients with extra-articular manifestations and undiagnosed back pain have a high prevalence of axSpA and referral to a rheumatologist should constitute standard of care, especially if B27 positive. Disclosure of Interests: Walter P Maksymowych Grant/research support from: AbbVie, Pfizer, Janssen, Novartis, Consultant for: AbbVie, Eli Lilly, Boehringer, Galapagos, Janssen, Novartis, Pfizer and UCB Pharma; Chief Medical Officer for Canadian Research and Education Arthritis, Raj Carmona Grant/research support from: Amgen, Abbvie, Jannsen, Consultant for: Amgen, Abbvie, BMS, Eli Lilly, Merck, Novartis, Jannsen, Takeda, UCB, James Yeung: None declared, Jon Chan Grant/research support from: Janssen, UCB, Novartis, Pfizer, Celgene, Consultant for: Amgen, Celgene, Eli Lilly, Janssen, Amgen, Abbvie, Novartis, Pfizer, UCB, Sandoz, Merck, Liam Martin: None declared, Sibel Aydin Consultant for: Abbvie, Celgene, UCB, Novartis, Jannsen, Sanofi, Dianne Mosher: None declared, Ariel Masetto Grant/research support from: Amgen, Sanofi, Consultant for: Sanofi, Pfizer, Bristol-Myers Squibb, Novartis, Boehringer Ingelheim, Speakers bureau: Novartis, Stephanie Keeling Consultant for: AbbVie. Pfizer, Eli Lily, Janssen, Amgen, Astrzeeneca, UCB., Olga Ziouzina: None declared, Sherry Rohekar Consultant for: Abbvie, Amgen, BMS, Celgene, Eli-Lilly, Janssen, Merck, Novartis, Pfizer, Roche, Sanofi, UCB, Joel Paschke: None declared, Amanda Carapellucci: None declared, Robert G Lambert Consultant for: Bioclinica, Parexel, Abbvie |
