Original Article
Comparison of 2 Referral Strategies for the Diagnosis of Axial Spondyloarthritis in Spain. The RADAR Study
Comparación de 2 estrategias de derivación en el diagnóstico de la espondiloartritis axial en España. Estudio RADAR
Xavier Juanolaa, José Luis Fernández-Sueirob, Juan Carlos Torre-Alonsoc, Roberto Miguélezd, Santiago Muñoz-Fernándeze, Javier Ballinaf, Carlos Gonzálezg, Berta Juliáh, Luis Cea-Calvoh,
, Eduardo Collantesi
Corresponding author
a Servicio de Reumatología, Hospital Universitari de Bellvitge, IDIBELL, Barcelona, Spain
b Servicio de Reumatología, INIBIC, Complejo Hospitalario Universitario La Coruña, La Coruña, Spain
c Servicio de Reumatología, Hospital Monte Naranco, Oviedo, Spain
d Servicio de Reumatología, Hospital General de Móstoles, Madrid, Spain
e Servicio de Reumatología, Hospital Universitario Infanta Sofía, Madrid, Spain
f Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
g Servicio de Reumatología, Hospital Universitario Gregorio Marañón, Madrid, Spain
h Medical Affairs, Merck Sharp & Dohme de Spain, Madrid, Spain
i Servicio de Reumatología, Hospital Universitario Reina Sofía/Intituto Maimónides de Investigación Biomedica de Córdoba/Universidad de Córdoba, Córdoba, Spain
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Estudio RADAR" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Axial spondylitis is an inflammatory disease that primarily affects the spinal column and has a worldwide prevalence of 0.5%–1% including<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> earlier stages of disease. The paradigmatic expression of the disease is ankylosing spondylitis (AS). Although in its early stages it may predominantly affect the sacroiliac joints, disease progression produces vertebral involvement at all levels.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">It is a known fact that axial spondyloarthritis usually starts insidiously at an early age (before 40 years) with chronic back pain and between 7 and 9 years pass before the onset of symptoms establishing a correct etiologic diagnosis.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> In our country, the REGISPONSER study showed that the diagnosis of AS was made with an average delay of 8 years from the onset of symptoms.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This delay in diagnosis also involves a delay in establishing the most appropriate treatment for each patient, and the adverse consequences of untreated disease can decrease the quality of life of patients, causing prolonged work disability and increase the economic burden of the disease.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The axial spondyloarthritis and AS may be diagnosed using a series of clinical, radiological and laboratory tests accessible to rheumatology clinics<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9</span></a> and, therefore, early referral of patients with axial symptoms to rheumatology clinics can reduce the time delay in diagnosis and allow proper treatment of the patient in an early stage.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of the <span class="elsevierStyleItalic">Recognizing And Diagnosing Ankylosing Spondylitis Reliably</span> (RADAR) study was to determine whether a simple derivation strategy for patients with chronic low back pain to rheumatology clinics was similar to a strict strategy to identify patients with a final diagnosis of axial spondyloarthritis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Here we report the results of the sample of patients included in Spain.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">The RADAR study is a multicenter, multinational study in which young patients with chronic low back pain were randomly distributed to one of two strategies. The primary objective of the study was to compare the two strategies of referral of patients with chronic low back pain from primary care rheumatology clinics regarding the final diagnosis of axial spondyloarthritis.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Other objectives were to assess the usefulness of each criterion, exploring what referral criteria showed the highest yield for the diagnosis of axial spondyloarthritis, assessed according to what criteria determined whether patients were derived, and the degree of agreement between the primary care physician and the rheumatologist in the presence each criterion.</p><p id="par0035" class="elsevierStylePara elsevierViewall">To do this, centers from 16 countries (8 centers in Spain) with networks that included primary care centers for referral and diagnosis of patients with low back pain potentially affected by axial spondyloarthritis were selected. The centers included patients with the following characteristics: (1) chronic back pain (more than 3 months) of unknown origin, (2) age at onset of pain<45 years, and (3) no previous diagnosis of axial spondyloarthritis or AS.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Each center was assigned by a randomization ratio 1:1, a strategy for referring these patients to rheumatology clinics so that each health center referred all patients with a single strategy. Centers assigned to referral strategy 1 sent patients if they met one of the following three criteria: inflammatory back pain, HLA-B27 positive or sacroiliitis on imaging test. Centers assigned to referral strategy 2 sent patients if they met two of the following six criteria: inflammatory back pain, HLA-B27, sacroiliitis on imaging test, family history of axial spondyloarthritis, extra-articular manifestations and a good response to NSAIDs.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The rheumatologist established the final diagnosis of the patients referred after conducting additional testing if deemed relevant, and this was the patient's final diagnosis. With the final diagnosis, patients were classified as definite axial spondyloarthritis (radiographic or non radiographic), possible axial spondyloarthritis (suspected cases without definitive diagnosis) or no axial spondyloarthritis.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The study included a total of 1072 patients, 1049 of whom completed the study.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In Spain we included 88 patients, of whom 87 completed the study and are included in this article.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The primary study analysis compared the proportion of patients with a final diagnosis of definite axial spondyloarthritis taking into account both strategies. For the primary analysis a binomial test was used for the difference in the percentage of patients with a final diagnosis of axial spondyloarthritis. The degree of agreement between the primary care physician and the rheumatologist was based on the presence of each criterion individually assessed by the percentage of patients referred due to a particular positive criterion according to the primary care physician and with whom the rheumatologist agreed positivitively.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient Characteristics</span><p id="par0055" class="elsevierStylePara elsevierViewall">In Spain we included 88 patients (60 patients were referred with strategy 1 and 28 with strategy 2), of which 87 completed the study (one patient of strategy 1 was lost to follow-up). The average age of the patients was 36.8 years (SD 8.7), 55.7% were female and 44.3% male. No demographic differences were observed in patients assigned to any of the 2 strategies (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Primary Objective. Diagnosis of Axial Spondyloarthritis</span><p id="par0060" class="elsevierStylePara elsevierViewall">No differences were seen in the final diagnoses issued by rheumatologists between both strategies. The definitive diagnosis of axial spondyloarthritis was performed in 25.4% (n=15) patients of strategy 1 and 28.6% (n=8) of Strategy 2 (<span class="elsevierStyleItalic">P</span>=NS). There were no differences in the percentage of patients in which the axial spondyloarthritis considered as ruled out. The final diagnosis of the patients is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Criteria for Referral of Patients and Their Usefulness</span><p id="par0065" class="elsevierStylePara elsevierViewall">Inflammatory back pain was the criterion most used to refer the patient (100% of patients in both strategies). In strategy 2, the response to NSAIDs was used for 18 patients (64.3%), while the other criteria were seldom used (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). In inflammatory back pain (n=88), the agreement of the rheumatologist in the presence of inflammatory back pain was 75%. The agreement was also high for the presence of HLA-B27 positivity (90%), but was low for the presence of sacroiliitis on imaging techniques (20%) although these criteria were seldomly employed by the primary care physician (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). The most sensitive referral criteria were inflammatory back pain (78.3%) and a good response to NSAIDs (77.3%), while all had a high negative predictive value, especially sacroiliitis and a good response to NSAIDs (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The analysis of the patients included in the RADAR study in Spain shows that both referral strategies led to a similar percentage of diagnoses of definite axial spondyloarthritis (25.4% and 28.6% respectively). The simplest referral strategy (one of three criteria) had a similar efficacy as the more complex strategy (two of six criteria) for the diagnosis of this disease.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The sample data included in Spain was consistent with the overall study data, which included 1072 patients, which showed a percent of definitive axial spondyloarthritis diagnosis of 37.8% and 35.6% respectively.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The percentage of patients diagnosed with definite axial spondyloarthritis in Spain compared to the overall sample was slightly lower. This is due to the inclusion in some of the participating countries of patients with more symptoms and activity (expressed by parameters such as BASDAI, BASFI, BASMI, higher CRP and ESR) in which the percentage with a final diagnosis of definite axial spondyloarthritis was higher. The results are also in line with a recent study carried out in Germany with 2 very similar referral strategies.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Randomization was performed by study sites (each site referred patients according to one approach) and this is the reason for the difference in sample size of two strategies (60 and 28 patients, respectively), since the centers assigned to strategy 2 recruited fewer patients. In the Spanish sample, inflammatory back pain was used as a criterion for referral for all patients, and the correlation between primary care physicians and rheumatologists was relatively high (75%). This was also the main criterion for referral in the overall sample. In patients in Spain, sacroiliitis and other referral criteria were used rarely. Furthermore, the observed agreement for the diagnosis of sacroiliitis on imaging tests was particularly low in the Spanish sample (20%), with respect to the overall sample (64.2%). This, coupled with the low availability of HLA-B27 in primary care, suggests that LBP of inflammatory characteristics should be the main criterion for referral of early diagnosis cases. The high sensitivity and negative predictive value of inflammatory back pain in the study, important requirements for a test to be useful for screening patients, together with the fact that it is a purely clinical assessment, support its usefulness as a criterion of suspicion and referral.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Today, a patient typically waits between 7 and 9 years from the start of symptoms to having an established diagnosis of AS,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5–7</span></a> but in the early stages, even without changes on conventional imaging, the disease burden for patient is similar in terms of symptoms and constraints.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> Several studies in Spain have shown that the implementation of protocols for suspected spondyloarthritis improves early diagnosis of this disease.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> It is of particular interest to note that in studies in which the disease is actively looked for there is always a significant percentage of patients with low back pain with axial spondyloarthritis who were not previously identified, hence the importance of correct interpretation of lumbar inflammatory pain. In this regard, the <span class="elsevierStyleItalic">Assessment of Spondyloarthritis International Society</span> (ASAS) and the <span class="elsevierStyleItalic">European Study Group for Spondyloarthropathy</span> (ESSG) have issued simple definitions based on inflammatory back pain onset before 40 years (45 in the case of ESSG), improvement with exercise and no improvement with rest, the insidious onset and the presence of pain at night.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">16,17</span></a> In the RADAR study the age of cutoff was before 45 years, which can probably help detect the disease in patients with late onset forms more often.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The main limitation of the study is that, since the analysis was made on a small group of patients (those recruited in Spain), the statistical power is insufficient to draw firm conclusions. For this reason, the data are for descriptive purposes only. The main interest is to show the situation in our country. The fact that of 88 patients included in the study in Spain just over a quarter (23 patients) were diagnosed with definite axial spondyloarthritis by the rheumatologist suggested that there should be more intense training for suspicion of this entity in primary care, and that we should improve the referral of these patients to rheumatology for early diagnosis and treatment.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In summary, the analysis of patients in Spain included in the RADAR study is in line with the results in the overall study population and shows that, in patients with chronic back pain, a simple strategy for referral to rheumatology based primarily on the presence of inflammatory low back pain is as effective as a more conservative approach (two of six criteria) for diagnosing axial spondyloarthritis. Furthermore, the correlation in the diagnosis of inflammatory back pain between primary care physician and rheumatologist was reasonably good. Applying a simple referral protocol, based on the identification of inflammatory back pain may accelerate the diagnosis of these patients and the establishment of appropriate treatment, thereby minimizing the current burden of axial spondyloarthritis currently.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Ethical Responsibilities</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Protection of people and animals</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors state that no experiments were performed on humans or animals.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Data confidentiality</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace regarding the publication of data from patients and all patients included in the study have received sufficient information and gave their written informed consent to participate in this study.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Right to privacy and informed consent</span><p id="par0110" class="elsevierStylePara elsevierViewall">The authors have obtained informed consent from patients and/or subjects referred to in the article. This document is in the possession of the author of correspondence.</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflict of Interests</span><p id="par0115" class="elsevierStylePara elsevierViewall">Berta Julia and Luis Cea-Calvo are full-time employees at Merck Sharp & Dohme of Spain. The rest of the authors received financial compensation for participation in the study. Dr. Eduardo Collantes is a member of the <span class="elsevierStyleItalic">Advisory Board</span> of Pfizer, and has received a grant from Merck Sharp & Dohme.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres293720" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objectives" 2 => "Patients and methods" 3 => "Results" 4 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec277706" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres293719" "titulo" => array:5 [ 0 => "Resumen" 1 => "Objetivos" 2 => "Pacientes y métodos" 3 => "Resultados" 4 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec277707" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 6 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Patient Characteristics" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Primary Objective. Diagnosis of Axial Spondyloarthritis" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Criteria for Referral of Patients and Their Usefulness" ] ] ] 7 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 8 => array:3 [ "identificador" => "sec0040" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0045" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0050" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0055" "titulo" => "Right to privacy and informed consent" ] ] ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Conflict of Interests" ] 10 => array:2 [ "identificador" => "xack68497" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2012-11-07" "fechaAceptado" => "2013-02-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec277706" "palabras" => array:4 [ 0 => "Inflammatory back pain" 1 => "Spondyloarthritis" 2 => "Ankylosing spondylitis" 3 => "Referral" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec277707" "palabras" => array:4 [ 0 => "Dolor lumbar" 1 => "Espondiloartropatías" 2 => "Espondilitis anquilosante" 3 => "Derivación" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Improving referral of patients with back pain to rheumatologists could accelerate the diagnosis of axial spondyloarthritis. The RADAR study compared two strategies in the referral of patients with chronic back pain (>3 months) with an onset before the age of 45 years from primary care centers to rheumatology departments, in relation to the diagnosis of axial spondyloarthritis.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Each primary care center was assigned a referral strategy for its patients: (a) strategy 1, patients who had one of the 3 following criteria: inflammatory back pain, HLA-B27 positivity or sacroiliitis in imaging; or (b) strategy 2, patients who had 2 of the following 6: inflammatory back pain, HLA-B27 positivity, sacroiliitis in imaging, family history of axial spondyloarthritis, extra-articular manifestations or good response to nonsteroidal antiinflammatory drugs. The rheumatologist established the final diagnosis.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eighty-eight Spanish patients (mean age 36.8 years [SD 8.7], 55.7% females and 44.3% males) were referred for evaluation, 60 patients under strategy 1 and 28 under strategy 2. A definitive diagnosis of axial spondyloarthritis was established in 25.4% with strategy 1 and in 28.6% with strategy 2 (<span class="elsevierStyleItalic">P</span>=NS). Inflammatory back pain was the criterion most commonly used for referral, and the agreement rate between the primary care physician and rheumatologist was 75%.</p> <span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A simple referral strategy based on one of three criteria proved as effective as a strategy based on two of six criteria in diagnosing axial spondyloarthritis. Inflammatory back pain was the criterion most commonly used for patient referral.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Mejorar la derivación de pacientes con dolor lumbar a reumatología podría acelerar el diagnóstico de la espondiloartritis axial. El estudio RADAR comparó 2 estrategias de derivación de pacientes con dolor lumbar crónico (> 3 meses) de inicio antes de los 45 años desde atención primaria a reumatología con respecto al diagnóstico de espondiloartritis axial.</p> <span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Se asignó una estrategia a cada centro de salud para derivar a sus pacientes: (a) estrategia 1, si cumplían uno de los siguientes 3 criterios: dolor lumbar inflamatorio, HLA-B27 positivo o sacroilitis en prueba de imagen; (b) estrategia 2, si cumplían 2 de 6: dolor lumbar inflamatorio, HLA-B27 positivo, sacroilitis en prueba de imagen, historia familiar de espondiloartritis axial, manifestaciones extraarticulares y buena respuesta a antiinflamatorios no esteroideos. El reumatólogo estableció el diagnóstico final.</p> <span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Ochenta y ocho pacientes (edad 36,8 años [DE 8,7]; 55,7% mujeres y 44,3% hombres) en España fueron derivados, 60 usando la estrategia 1 y 28 la estrategia 2. El diagnóstico de espondiloartritis axial definitiva se realizó en el 25,4% de los pacientes en la estrategia 1 y en el 28,6% en la estrategia 2 (p = NS). El dolor lumbar inflamatorio fue el criterio de derivación más utilizado y la concordancia entre médico de atención primaria y reumatólogo fue del 75%.</p> <span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una estrategia de derivación sencilla, basada en uno de 3 criterios, fue igual de eficaz que una estrategia basada en 2 de 6 criterios para el diagnóstico de espondiloartritis axial. El dolor lumbar inflamatorio fue el criterio más utilizado para la derivación.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as: Juanola X, et al. Comparación de 2 estrategias de derivación en el diagnóstico de la espondiloartritis axial en España. Estudio RADAR. Reumatol Clin. 2013;9:348–352.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">BASDAI, Bath Ankylosing Spondylitis Disease Activity Index; BASFI, Bath Ankylosing Spondylitis Functional Index; BASMI, Bath Ankylosing Spondylitis Metrology Index; SD, standard deviation; CRP C, reactive protein; ESR, erythrocyte sedimentation rate.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 1 (n=60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 2 (n=28) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean age, years (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.5 (8.5) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.3 (9.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Percentage of men and women, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43/57 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">46/54 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Caucasian, % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">98.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">92.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CRP, mean (SD) (mg/dl) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.7 (10.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.2 (12.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ESR, mean (SD) (mm/h) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.4 (10.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12.1 (15.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BASMI, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.5 (0.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.6 (1.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BASFI, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.3 (2.2) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.9 (1.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">BASDAI, mean (SD) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.1 (2.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.6 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab427645.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Baseline Characteristics of Patients.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">One patient from strategy 1 was not evaluated.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 1 (n=60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 2 (n=28) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Definite axial spondyloarthritis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (25.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (28.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Radiographic (ankylosing spondylitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (10.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (21.4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non radiographic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (15.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Possible axial spondyloarthritis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7.1%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">No axial spondyloarthritis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (69.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (64.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab427642.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Final Diagnosis of Patients in Each Referral Strategy (<span class="elsevierStyleItalic">P</span>=NS for all Comparisons).</p>" ] ] 2 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NSAID, nonsteroidal anti-inflammatory drugs; HLA, human leukocyte antigen.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Criteria used by the primary care physician</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Agreement with the rheumatologist in the presence of each criterion</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 1 (n=60), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 2 (n=28), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total (n=88), n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 1, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Strategy 2, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Total, n (%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory back pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">88 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (75.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">19 (73.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">60 (75.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sacroiliitis on imaging test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (8.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (20) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (20) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HLA-B27 + \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (11.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (11.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (85.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (90) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extra-articular manifestations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (17.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.60 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (7.1) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good response to NSAIDs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 (64.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (60) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab427644.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The agreement with the rheumatologist is the percentage of those subjects referred due to a certain criterion defined as positive by the PCP and who were also positive according to rheumatologist assessment. We only included patients in which assessments were made by both and have no lost data.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Criteria Used by the Primary Care Physician for Referral, and Agreement<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a> With the Rheumatologist in the Presence of Each Criterion.</p>" ] ] 3 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">NSAIDs, non steroidal anti-inflammatory drugs; HLA, human leukocyte antigen; NPV, negative predictive value; PPV, positive predictive value.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">P PV,<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">NPV,<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Sensitivity,<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> % \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Specificity,<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a> % \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Inflammatory back pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">72.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sacroiliitis on imaging test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65.2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HLA-B27+ \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Extra-articular manifestations \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">83.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">96.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Family history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">70.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">78.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.8 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Good response to NSAIDs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">84.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56.0 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab427643.png" ] ] ] "notaPie" => array:4 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Percentage of patients assessed as positive for the criteria that were diagnosed with definite axial spondyloarthritis.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Percentage of patients assessed as negative for the criteria who were not diagnosed with definite axial spondyloarthritis.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Percentage of patients diagnosed with final axial spondyloarthritis who had been evaluated as positive.</p>" ] 3 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "d" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Percentage of patients ultimately not diagnosed with axial spondyloarthritis where the criterion was evaluated as negative.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Predictive Values, Sensitivity and Specificity of Each Individual Referral Criterion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:17 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. 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García-Yébenes" 5 => "E. de Miguel" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/ard.2010.141200" "Revista" => array:6 [ "tituloSerie" => "Ann Rheum Dis" "fecha" => "2011" "volumen" => "70" "paginaInicial" => "827" "paginaFinal" => "830" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21242234" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "New criteria for inflammatory back pain in patients with chronic back pain: a real patient exercise by experts from the Assessment of SpondyloArthritis international Society (ASAS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Sieper" 1 => "D. van der Heijde" 2 => "R. Landewé" 3 => "J. Brandt" 4 => "R. Burgos-Vagas" 5 => "E. 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Calin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "1991" "volumen" => "34" "paginaInicial" => "1218" "paginaFinal" => "1227" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1930310" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack68497" "titulo" => "Acknowledgments" "texto" => "<p id="par0120" class="elsevierStylePara elsevierViewall">The study <span class="elsevierStyleItalic">Recognizing And Diagnosing Ankylosing Spondylitis Reliably</span> (RADAR) was funded by Schering-Plough (now Merck & Co., Whitehouse Station, New Jersey, USA). The study involved researchers from 16 countries. We thank the coordinators consent to the publication of local data.</p> <p id="par0125" class="elsevierStylePara elsevierViewall">Dr. Jose Luis Fernandez-Sueiro died in the period in which this manuscript was in review. We want to recognize his work in this study and manuscript and to show the deepest gratitude for all his teachings.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/21735743/0000000900000006/v1_201311210124/S217357431300107X/v1_201311210124/en/main.assets" "Apartado" => array:4 [ "identificador" => "17338" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/21735743/0000000900000006/v1_201311210124/S217357431300107X/v1_201311210124/en/main.pdf?idApp=UINPBA00004M&text.app=https://reumatologiaclinica.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357431300107X?idApp=UINPBA00004M" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 38 | 34 | 72 |
| 2024 September | 64 | 23 | 87 |
| 2024 August | 75 | 28 | 103 |
| 2024 July | 64 | 26 | 90 |
| 2024 June | 66 | 29 | 95 |
| 2024 May | 87 | 31 | 118 |
| 2024 April | 72 | 23 | 95 |
| 2024 March | 66 | 40 | 106 |
| 2024 February | 43 | 27 | 70 |
| 2024 January | 42 | 21 | 63 |
| 2023 December | 36 | 34 | 70 |
| 2023 November | 52 | 37 | 89 |
| 2023 October | 49 | 27 | 76 |
| 2023 September | 116 | 40 | 156 |
| 2023 August | 53 | 22 | 75 |
| 2023 July | 49 | 28 | 77 |
| 2023 June | 42 | 29 | 71 |
| 2023 May | 68 | 29 | 97 |
| 2023 April | 34 | 15 | 49 |
| 2023 March | 55 | 39 | 94 |
| 2023 February | 44 | 37 | 81 |
| 2023 January | 26 | 28 | 54 |
| 2022 December | 74 | 50 | 124 |
| 2022 November | 53 | 38 | 91 |
| 2022 October | 71 | 63 | 134 |
| 2022 September | 69 | 42 | 111 |
| 2022 August | 54 | 45 | 99 |
| 2022 July | 44 | 40 | 84 |
| 2022 June | 47 | 39 | 86 |
| 2022 May | 37 | 47 | 84 |
| 2022 April | 63 | 48 | 111 |
| 2022 March | 73 | 65 | 138 |
| 2022 February | 43 | 52 | 95 |
| 2022 January | 54 | 38 | 92 |
| 2021 December | 34 | 47 | 81 |
| 2021 November | 31 | 45 | 76 |
| 2021 October | 30 | 42 | 72 |
| 2021 September | 27 | 28 | 55 |
| 2021 August | 24 | 35 | 59 |
| 2021 July | 28 | 26 | 54 |
| 2021 June | 21 | 33 | 54 |
| 2021 May | 44 | 28 | 72 |
| 2021 April | 36 | 35 | 71 |
| 2021 March | 39 | 22 | 61 |
| 2021 February | 39 | 18 | 57 |
| 2021 January | 27 | 15 | 42 |
| 2020 December | 30 | 14 | 44 |
| 2020 November | 33 | 18 | 51 |
| 2020 October | 24 | 9 | 33 |
| 2020 September | 35 | 17 | 52 |
| 2020 August | 14 | 11 | 25 |
| 2020 July | 25 | 11 | 36 |
| 2020 June | 23 | 21 | 44 |
| 2020 May | 16 | 13 | 29 |
| 2020 April | 24 | 15 | 39 |
| 2020 March | 3 | 7 | 10 |
| 2020 February | 2 | 0 | 2 |
| 2019 April | 2 | 0 | 2 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 120 | 9 | 129 |
| 2018 March | 43 | 6 | 49 |
| 2018 February | 28 | 2 | 30 |
| 2018 January | 24 | 6 | 30 |
| 2017 December | 27 | 5 | 32 |
| 2017 November | 31 | 8 | 39 |
| 2017 October | 27 | 3 | 30 |
| 2017 September | 23 | 5 | 28 |
| 2017 August | 46 | 3 | 49 |
| 2017 July | 32 | 6 | 38 |
| 2017 June | 63 | 6 | 69 |
| 2017 May | 71 | 15 | 86 |
| 2017 April | 36 | 3 | 39 |
| 2017 March | 45 | 4 | 49 |
| 2017 February | 20 | 4 | 24 |
| 2017 January | 22 | 4 | 26 |
| 2016 December | 50 | 18 | 68 |
| 2016 November | 37 | 7 | 44 |
| 2016 October | 58 | 16 | 74 |
| 2016 September | 62 | 4 | 66 |
| 2016 August | 61 | 7 | 68 |
| 2016 July | 38 | 5 | 43 |
| 2016 May | 1 | 7 | 8 |
| 2016 April | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 1 | 0 | 1 |
| 2015 September | 3 | 0 | 3 |
| 2015 August | 1 | 0 | 1 |
| 2015 July | 20 | 9 | 29 |
| 2015 June | 46 | 19 | 65 |
| 2015 May | 64 | 23 | 87 |
| 2015 April | 29 | 13 | 42 |
| 2015 March | 19 | 9 | 28 |
| 2015 February | 19 | 14 | 33 |
| 2015 January | 23 | 7 | 30 |
| 2014 December | 45 | 11 | 56 |
| 2014 November | 26 | 14 | 40 |
| 2014 October | 31 | 18 | 49 |
| 2014 September | 29 | 13 | 42 |
| 2014 August | 28 | 19 | 47 |
| 2014 July | 37 | 13 | 50 |
| 2014 June | 66 | 17 | 83 |
| 2014 May | 43 | 25 | 68 |
| 2014 April | 46 | 21 | 67 |
| 2014 March | 62 | 21 | 83 |
| 2014 February | 49 | 23 | 72 |
| 2014 January | 53 | 27 | 80 |
| 2013 December | 57 | 26 | 83 |
| 2013 November | 19 | 7 | 26 |
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