Evidence-based recommendations for the diagnosis of ankylosing spondylitis: results from the Australian 3E initiative in rheumatology

Abstract

• As part of the 3E program, we conducted a systematic literature review and gathered consensus from 23 practising Australian rheumatologists to develop guidelines for early identification of ankylosing spondylitis and specialist referral. • In three rounds of break-out sessions followed by discussion and voting, the specialist panel addressed three questions related to diagnosis of ankylosing spondylitis: 􀂾 In individuals with back pain, what are the early clinical features that suggest ankylosing spondylitis? 􀂾 How useful is imaging in identifying early ankylosing spondylitis? 􀂾 Based on which clinical features should a general practitioner refer a patient to a rheumatologist for further evaluation? • The panel agreed on six recommendations related to the three questions: 􀂾 1a. Early clinical features to suggest ankylosing spondylitis include inflammatory back pain and age at symptom onset <45 years. 􀂾 1b. The absence of symptomatic response to an appropriate course of non-steroidal anti-inflammatory drugs makes the diagnosis of ankylosing spondylitis less likely. 􀂾 1c. Raised inflammatory markers are supportive, but their absence does not rule out the diagnosis of ankylosing spondylitis. 􀂾 2a. Despite low sensitivity to detect changes of early ankylosing spondylitis, plain radiographs of the pelvis and spine are appropriate initial imaging techniques. 􀂾 2b. Magnetic resonance imaging is a useful imaging modality for detecting early changes of ankylosing spondylitis. 􀂾 3. Individuals with inflammatory back pain should be referred to a rheumatologist for further evaluation. • Effective dissemination and implementation of these recommendations are important to standardise the approach MJA 2008; 188: 235–237 to early diagnosis of ankylosing spondylitis.