Performance of referral strategies for spondyloarthritis

a population-based nationwide study

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVES: To evaluate the performance of the referral strategy (RS) for SpA of a nationwide epidemiological study (EpiReumaPt), as compared with previously proposed RSs. METHODS: EpiReumaPt was a three-stage national epidemiologic study. In phase one, 10 661 adult participants were randomly selected and screened for rheumatic and musculoskeletal diseases. In the second phase, positive screenings for ⩾1 rheumatic and musculoskeletal disease plus 20% negative screenings were assessed by a rheumatologist. Finally, three rheumatologists revised all the information and defined the final diagnosis. All participants from phase two were included. Thirteen RS were tested against the SpA diagnosis using several metrics, including sensitivity, specificity, the post-test probability of SpA given a positive RS (positive predictive value) and given a negative RS (1 - negative predictive value). RESULTS: From the total 3877 participants, 92 received a SpA diagnosis [weighted national prevalence: 1.6% (95% confidence interval: 1.2, 2.1)]. Modified versions of the Assessment of SpondyloArthritis international Society-RS and EpiReumaPt-RS were the most sensitive (85% and 72%, respectively) and yielded the lowest post-test probabilities of SpA if negative (0.6% and 0.7%, respectively). Considering the national prevalence (pre-test probability) of SpA (1.6%), a negative screening by these two RSs decreased the probability of SpA substantially (Assessment of SpondyloArthritis international Society: -63%; EpiReumaPt: -56%). Other RSs performed less well in reducing disease probability (range: -6.3%; -37.5%). Overall, the probability of SpA given a positive RS was small (positive predictive value range: 2.2%; 7.6%) and the EpiReumaPt RS yielded the best balance between sensitivity and positive predictive value. CONCLUSION: The proposed EpiReumaPt RS performed the best as a screening tool for SpA in patients from the general population when laboratory and imaging data were not available.

Original languageEnglish
Pages (from-to)1086-1094
Number of pages9
JournalRheumatology (Oxford, England)
Volume58
Issue number6
DOIs
Publication statusPublished - 1 Jun 2019

Fingerprint

Referral and Consultation
Population
Musculoskeletal Diseases
Rheumatic Diseases
Epidemiologic Studies
Confidence Intervals
Sensitivity and Specificity

Keywords

  • early diagnosis
  • referral strategies
  • spondyloarthritis

Cite this

@article{97989d56ef1d44ee802685207629e947,
title = "Performance of referral strategies for spondyloarthritis: a population-based nationwide study",
abstract = "OBJECTIVES: To evaluate the performance of the referral strategy (RS) for SpA of a nationwide epidemiological study (EpiReumaPt), as compared with previously proposed RSs. METHODS: EpiReumaPt was a three-stage national epidemiologic study. In phase one, 10 661 adult participants were randomly selected and screened for rheumatic and musculoskeletal diseases. In the second phase, positive screenings for ⩾1 rheumatic and musculoskeletal disease plus 20{\%} negative screenings were assessed by a rheumatologist. Finally, three rheumatologists revised all the information and defined the final diagnosis. All participants from phase two were included. Thirteen RS were tested against the SpA diagnosis using several metrics, including sensitivity, specificity, the post-test probability of SpA given a positive RS (positive predictive value) and given a negative RS (1 - negative predictive value). RESULTS: From the total 3877 participants, 92 received a SpA diagnosis [weighted national prevalence: 1.6{\%} (95{\%} confidence interval: 1.2, 2.1)]. Modified versions of the Assessment of SpondyloArthritis international Society-RS and EpiReumaPt-RS were the most sensitive (85{\%} and 72{\%}, respectively) and yielded the lowest post-test probabilities of SpA if negative (0.6{\%} and 0.7{\%}, respectively). Considering the national prevalence (pre-test probability) of SpA (1.6{\%}), a negative screening by these two RSs decreased the probability of SpA substantially (Assessment of SpondyloArthritis international Society: -63{\%}; EpiReumaPt: -56{\%}). Other RSs performed less well in reducing disease probability (range: -6.3{\%}; -37.5{\%}). Overall, the probability of SpA given a positive RS was small (positive predictive value range: 2.2{\%}; 7.6{\%}) and the EpiReumaPt RS yielded the best balance between sensitivity and positive predictive value. CONCLUSION: The proposed EpiReumaPt RS performed the best as a screening tool for SpA in patients from the general population when laboratory and imaging data were not available.",
keywords = "early diagnosis, referral strategies, spondyloarthritis",
author = "Sepriano, {Alexandre Rocha} and Sofia Ramiro and Ara{\'u}jo, {Filipe C.} and Machado, {Pedro M.} and Rodrigues, {Ana M.} and N{\'e}lia Gouveia and M{\'o}nica Eus{\'e}bio and Helena Canh{\~a}o and Jaime Branco",
year = "2019",
month = "6",
day = "1",
doi = "10.1093/rheumatology/key436",
language = "English",
volume = "58",
pages = "1086--1094",
journal = "Rheumatology (Oxford, England)",
issn = "1462-0332",
publisher = "Oxford University Press",
number = "6",

}

TY - JOUR

T1 - Performance of referral strategies for spondyloarthritis

T2 - a population-based nationwide study

AU - Sepriano, Alexandre Rocha

AU - Ramiro, Sofia

AU - Araújo, Filipe C.

AU - Machado, Pedro M.

AU - Rodrigues, Ana M.

AU - Gouveia, Nélia

AU - Eusébio, Mónica

AU - Canhão, Helena

AU - Branco, Jaime

PY - 2019/6/1

Y1 - 2019/6/1

N2 - OBJECTIVES: To evaluate the performance of the referral strategy (RS) for SpA of a nationwide epidemiological study (EpiReumaPt), as compared with previously proposed RSs. METHODS: EpiReumaPt was a three-stage national epidemiologic study. In phase one, 10 661 adult participants were randomly selected and screened for rheumatic and musculoskeletal diseases. In the second phase, positive screenings for ⩾1 rheumatic and musculoskeletal disease plus 20% negative screenings were assessed by a rheumatologist. Finally, three rheumatologists revised all the information and defined the final diagnosis. All participants from phase two were included. Thirteen RS were tested against the SpA diagnosis using several metrics, including sensitivity, specificity, the post-test probability of SpA given a positive RS (positive predictive value) and given a negative RS (1 - negative predictive value). RESULTS: From the total 3877 participants, 92 received a SpA diagnosis [weighted national prevalence: 1.6% (95% confidence interval: 1.2, 2.1)]. Modified versions of the Assessment of SpondyloArthritis international Society-RS and EpiReumaPt-RS were the most sensitive (85% and 72%, respectively) and yielded the lowest post-test probabilities of SpA if negative (0.6% and 0.7%, respectively). Considering the national prevalence (pre-test probability) of SpA (1.6%), a negative screening by these two RSs decreased the probability of SpA substantially (Assessment of SpondyloArthritis international Society: -63%; EpiReumaPt: -56%). Other RSs performed less well in reducing disease probability (range: -6.3%; -37.5%). Overall, the probability of SpA given a positive RS was small (positive predictive value range: 2.2%; 7.6%) and the EpiReumaPt RS yielded the best balance between sensitivity and positive predictive value. CONCLUSION: The proposed EpiReumaPt RS performed the best as a screening tool for SpA in patients from the general population when laboratory and imaging data were not available.

AB - OBJECTIVES: To evaluate the performance of the referral strategy (RS) for SpA of a nationwide epidemiological study (EpiReumaPt), as compared with previously proposed RSs. METHODS: EpiReumaPt was a three-stage national epidemiologic study. In phase one, 10 661 adult participants were randomly selected and screened for rheumatic and musculoskeletal diseases. In the second phase, positive screenings for ⩾1 rheumatic and musculoskeletal disease plus 20% negative screenings were assessed by a rheumatologist. Finally, three rheumatologists revised all the information and defined the final diagnosis. All participants from phase two were included. Thirteen RS were tested against the SpA diagnosis using several metrics, including sensitivity, specificity, the post-test probability of SpA given a positive RS (positive predictive value) and given a negative RS (1 - negative predictive value). RESULTS: From the total 3877 participants, 92 received a SpA diagnosis [weighted national prevalence: 1.6% (95% confidence interval: 1.2, 2.1)]. Modified versions of the Assessment of SpondyloArthritis international Society-RS and EpiReumaPt-RS were the most sensitive (85% and 72%, respectively) and yielded the lowest post-test probabilities of SpA if negative (0.6% and 0.7%, respectively). Considering the national prevalence (pre-test probability) of SpA (1.6%), a negative screening by these two RSs decreased the probability of SpA substantially (Assessment of SpondyloArthritis international Society: -63%; EpiReumaPt: -56%). Other RSs performed less well in reducing disease probability (range: -6.3%; -37.5%). Overall, the probability of SpA given a positive RS was small (positive predictive value range: 2.2%; 7.6%) and the EpiReumaPt RS yielded the best balance between sensitivity and positive predictive value. CONCLUSION: The proposed EpiReumaPt RS performed the best as a screening tool for SpA in patients from the general population when laboratory and imaging data were not available.

KW - early diagnosis

KW - referral strategies

KW - spondyloarthritis

UR - http://www.scopus.com/inward/record.url?scp=85066503707&partnerID=8YFLogxK

U2 - 10.1093/rheumatology/key436

DO - 10.1093/rheumatology/key436

M3 - Article

VL - 58

SP - 1086

EP - 1094

JO - Rheumatology (Oxford, England)

JF - Rheumatology (Oxford, England)

SN - 1462-0332

IS - 6

ER -