Overview of evaluated referral strategies for axSpA
| Strategy | IBP | HLA-B27 | Good response to NSAIDs | Family history for SpA | Additional criteria | Refer if | IBP definition |
|---|---|---|---|---|---|---|---|
| Brandt I20 | + | + | − | − | − | ≥1/2 positive | (1) Morning stiffness >30 min (2) Pain at night or in the early morning (3) Improvement of back pain by exercise; IBP positive if ≥1/3 criteria |
| Brandt II | + | + | − | − | − | ≥1/2 positive | See Brandt I IBP positive if ≥2/3 criteria |
| Brandt III | + | + | − | − | − | ≥1/2 positive | See Brandt I IBP positive if ≥3/3 criteria |
| Hermann21 | + | − | − | − | − | 1/1 positive | Calin's criteria: ≥4/5 of the following: (1) Persistent back pain for ≥3 months (2) Age of onset <40 years (3) Insidious onset of back pain (4) Back pain relieved by exercise (5) Back stiffness especially in the morning |
| MASTER22 | + | + | + | +*(AS) | − | ≥2/4 positive | (1) Morning stiffness in the lower part of the spine >30 min (2) Improvement by exercise, not by rest (3) Awakening in the night because of back pain, with improvement by exercise |
| Braun IBP23 | − | − | + | − | Age at onset CBP≤35 years; waking up in the second half of the night; alternating buttock pain; improvement by movement, not rest | ≥2/5 positive | NA |
| RADAR24 | + | + | + | + | Extra-articular manifestations† | ≥2/5 positive | By referring physician's opinion (ie, any set of criteria) |
| RADAR 2/3 | + | − | + | − | Extra-articular manifestations | ≥2/3 positive | See RADAR |
| Braun two-step25 | − | (+) | − | − | Psoriasis; buttock pain; improvement of back pain by exercise (only if ≤1/3 positive, HLA-B27 is tested) | ≥2/3 or HLA-B27+ | NA |
| Braun two-step alt. | − | (+) | − | − | Psoriasis; alternating buttock pain; improvement of back pain by exercise (only if ≤1/3 positive, HLA-B27 is tested) | ≥2/3 or HLA-B27+ | NA |
| CaFaSpA ≥1pt26 | + | − | + | + | − | ≥1/3 positive | ASAS criteria: ≥4/5 of the following: (1) Age at onset <40 years (2) Insidious onset (3) Improvement with exercise (4) No improvement with rest (5) Pain at night (with improvement on getting up) |
| CaFaSpA ≥2pt | + | − | + | + | − | ≥1/3 positive | See CaFaSpA ≥1pt |
| ASAS27 | + | + | + | + | Peripheral manifestations;‡ extra-articular manifestations; elevated acute phase reactants§ | ≥1/7 positive | See CaFaSpA ≥1pt |
*In the MASTER strategy, positive family history for AS, not SpA, is used as a referral parameter.
†Extra-articular manifestations: uveitis, psoriasis and/or IBD.
‡Peripheral manifestations: arthritis, enthesitis and/or dactylitis.
§Acute phase reactants, CRP and/or ESR.
alt, alternative; AS, ankylosing spondylitis; ASAS, Assessment in SpondyloArthritis international Society; CBP, chronic back pain; CRP, C reactive protein; ESR, erythrocyte sedimentation rate; HLA, human leucocyte antigen; IBD, inflammatory bowel disease; IBP, inflammatory back pain; NA, not available; NSAIDs, non-steroidal anti-inflammatory drugs; RADAR, Recognising and Diagnosing Ankylosing Spondylitis Reliably; SpA, spondyloarthritis.