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Abstract
Background Currently there is great workload in rheumatologic clinics and a lot of variability in the type and number of potential measures for patients with axial SpA.
Objectives To standardize axial SpA evaluation in daily practice through the generation of two checklists (one for minimum and another of excellence).
Methods A qualitative study was performed. First, an expert panel was set up (8 rheumatologists with interest and experience in axial SpA). A focal group with patients was organized. Barriers and facilitators in the evaluation and management of patients with axial SpA was analyzed. A systematic literature review was performed in order to identify measures for axial SpA and methodological characteristics as their validity or impact in daily practice. All of this information was presented to the experts and discussed. As a result, a draft of variables for a proper evaluation of patients with axial SpA was proposed. Then, the experts evaluated different characteristics of these variables (validity, feasibility, impact, etc) and selected a feasible and relevant list of variables (minimum checklist, in case of busy clinics or less skilled professionals) and added some other interesting variables (excellence checklist, the ideal evaluation) to cover all the domains of the disease. With these variables an electronic and paper checklists were designed.
Results Two checklists were generated. The minimum checklist includes a) Personal history (date of symptoms start, date of diagnosis, family history of Crohn disease/ulcerative colitis, psoriasis, reactive arthritis, uveitis, spondyloarthritis, smoking status, peripheral disease, enthesitis, dactylitis, extra-articular manifestations, profession, physical activity, inflammatory low back pain; b) Comorbidity (arterial hypertension, Diabetes Mellitus, hypercholesterolemia, cardiovascular disease, gastric ulcers, depression, osteoporosis, others); c) Physical examination (enthesis, synovitis, hips, dactylitis, modified Schöber, thoracic expansion, cervical rotation); d) Activity control (ASDAS, BASDAI, physician VAS, d) Function: BASFI; e) Labs and imaging (hemogram, ESR, biochemistry, CRP, urine, axial and sacroiliac x-ray, HLA B-27); f) Treatments (NSAID, biologic therapy, cessations and reasons, other treatments, physical activity). In the excellence checklist along with the previous, the following variables were included: blood pressure, cardiac frequency, weight, height, BMI, abdominal perimeter, BASMI, lipids, 25-OH Vitamin-D, glicohaemoglobina, microalbuminuria, DEXA.
Conclusions These checklists for patients with axial SpA might help evaluate rheumatologists in daily practice in order to early recognition and management of comorbidities, disease activity and other outcomes.
Disclosure of Interest None declared