ArticleACR open rheumatology2020
Understanding Barriers in the Pathway to Diagnosis of Ankylosing Spondylitis: Results From a US Survey of 1690 Physicians From 10 Specialties.
Article in ACR open rheumatology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
15 citing papers in PubMed, 20 citations in OpenAlex.
- Efficacy and Safety of Intravenous Golimumab in Ankylosing Spondylitis Patients With Early and Late Disease Through One Year of the GO-ALIVE Study.Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases · 2022Trial
- HLA-B27 Testing in Clinical Practice: A Retrospective Analysis of Testing Indications and Rheumatology Referral Patterns.The Journal of rheumatology · 2025Article
- Patient Diagnostic Journey and Time to Diagnosis in Axial Spondyloarthritis: A Retrospective Cohort Study Using US Claims Data.Rheumatology and therapy · 2025Article
- Practice patterns and challenges in the referral, diagnosis, management, and monitoring of axial spondyloarthritis: insights from an online survey of rheumatologists.Rheumatology international · 2025Article
- Orthopaedic physicians' awareness, diagnostic challenges and referral barriers in axial spondyloarthritis: insights from a nationwide survey in Germany.Therapeutic advances in musculoskeletal disease · 2025Article
- An update on the management of axial spondyloarthritis for sports medicine professionals.BMC sports science, medicine & rehabilitation · 2024Review
- A critical view of WHO guidelines on management of low back pain.Nature reviews. Rheumatology · 2024Article
- Factors Associated With Diagnostic Delay in Axial Spondyloarthritis: Impact of Clinical Factors and Social Vulnerability.Arthritis care & research · 2024Article
- Article
- Axial Spondyloarthritis and Diagnostic Challenges: Over-diagnosis, Misdiagnosis, and Under-diagnosis.Current rheumatology reports · 2023Review
- The Impact of Spondyloarthritis on Health-Related Quality of Life and Healthcare Resource Utilization in Saudi Arabia: A Narrative Review and Directions for Future Research.Open access rheumatology : research and reviews · 2023Review
- Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades.RMD open · 2021Article
- Clinical Manifestations and Diagnosis of Axial Spondyloarthritis.Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases · 2021Review
- Axial spondyloarthritis 10 years on: still looking for the lost tribe.Rheumatology (Oxford, England) · 2020Review
- Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review.Rheumatology and therapy · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveEarly diagnosis of ankylosing spondylitis (AS) remains challenging because of the high prevalence of chronic back pain in patients initially treated by nonrheumatology health care providers (HCPs). We assessed the patient pathway to rheumatology referral, including HCP recognition of inflammatory back pain (IBP) and other features suggestive of AS, diagnostic workup, treatment, and referral to a specialist with the goal of identifying barriers to patient referral to a rheumatologist.
methodsUS HCPs from 10 specialties were invited to participate in a cross-sectional web-based survey on clinical characteristics and diagnostic measures leading to IBP suspicion and the subsequent referral process. Eligible HCPs were actively practicing and had referred a patient with suspected IBP or ocular findings (ophthalmology only) within 12 months. Data were analyzed descriptively.
resultsOf 1690 HCPs, 61% identified morning stiffness lasting more than 30 minutes, 29% sleep disturbance due to back pain, and 28% pain that improves with activity as features suggestive of IBP. Nearly two-thirds of primary care HCPs reported that they were the first HCPs consulted by patients with suspected IBP. Among HCPs ordering diagnostic blood work, approximately 90% selected antinuclear antibody and rheumatoid factor, whereas 76% selected human leukocyte antigen B27. Almost 40% would treat patients with suspected IBP themselves. HCPs cited lack of adequate specialists nearby (35.1%), insurance restrictions (47.1%), and long wait time (77.0%) as barriers to early referral.
conclusionMost HCPs had difficulty identifying features suggestive of IBP and indicated insurance restrictions and long wait times as barriers to early referral of patients with potential AS.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.