Abstract
Key messages
There is a relative lack of confidence among GPs in the assessment and management of IBP vs. mechanical back pain. A simple screening tool for SpA, applicable in primary care urgently needs to be developed. It is reasonable for patients with symptoms suggestive of inflammatory back pain to be referred to secondary care without further investigations.
Abstract
The objective of this study was to assess current practice of our local general practitioners (GPs) in using clinical features, as well as radiological and laboratory investigations to assess patients with IBP. An online, observational questionnaire-based survey was done in 10 West Midlands CCGs including disparate geographical and socioeconomic areas. The survey consisted of 23 questions based on Calin, Berlin and ESSG Criteria for spondyloarthropathies. GPs were asked to rate the importance of a range of symptoms as indications of IBP IBP (10 point scale, range 1–10), and what their views were on which were the most important treatments for patients with suspected inflammatory back pain(4 point scale, range 1–4). The 4 most important symptoms for predicting inflammatory back pain according to our local cohort of GPs were ‘morning stiffness’ ‘sleep disturbances caused by back pain’ ‘insidious onset’ and ‘age of onset’ < 45. Among the treatment options, NSAIDs were ranked as the most important treatment option for IBP. DMARDS were rated as the next most important treatment option, ahead of physiotherapy and anti-TNF therapy. This study has highlighted relative lack of confidence among GPs in the assessment of IBP. Whether this reflects a need for education or poor performance of these questions in primary care populations requires further study.
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Funding
The survey was funded by Abbvie but the company had no input into the analysis of the data or the preparation of the manuscript.
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TA has no conflicts of interest. AP has no conflicts of interest. RL has no conflicts of interest. AVP has no conflicts of interest. NB has received research funding from Abbvie, Novartis, Eli Lilly, honoraria from Novartis, Cellgene and a travel grant from Abbvie. SE has received a travel grant from Abbvie.
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This study was a questionnaire study of general practitioners so it did not involve any patients and therefore did not require ethics. Approval to conduct the study and contact the GPs was given by the local CCGs.
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Adizie, T., Elamanchi, S., Prabu, A. et al. Knowledge of features of inflammatory back pain in primary care in the West Midlands: a cross-sectional survey in the United Kingdom. Rheumatol Int 38, 1859–1863 (2018). https://doi.org/10.1007/s00296-018-4058-5
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DOI: https://doi.org/10.1007/s00296-018-4058-5