How to screen for axial spondyloarthritis in primary care?

There is a major delay of several years between first symptoms and making a diagnosis in patients with axial spondyloarthritis. A strategy for earlier diagnosis is urgently needed, for which efficient referral parameters applicable in primary care are an important part. Published studies on referral programs are reviewed and their relevance for daily clinical practice is discussed.

Several referral investigations have been performed in several countries using the symptom of 'inflammatory back pain' (IBP) alone or in combination with other referral parameters. All studies performed resulted in a good and acceptable percentage of an axial SpA diagnosis in between 29 and 58%. A set of rather simple parameters (IBP and/or HLA-B27 positivity and/or sacroiliitis on imaging) performed better than IBP alone and is easier to use than more complicated referral strategies.

Referral strategies to screen for axial SpA patients in primary care are available, are effective and should be applied more regularly.