{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T18:51:36Z","timestamp":1792522296268,"version":"4.5.0"},"reference-count":42,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2017,2,24]]},"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Several models have been proposed to refer patients with possible axial spondyloarthritis (axSpA) to a rheumatologist. Our aim was to evaluate performance of these models in a single cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>13 referral models found in the literature were evaluated in the Leiden SPondyloArthritis Caught Early (SPACE) cohort, which includes patients with back pain (\u22653\u2005months, \u22642\u2005years, onset &lt;45\u2005years; n=261) referred to a rheumatology outpatient clinic. Imaging was not considered as a referral parameter. Performance of the strategies was evaluated (sensitivity, specificity, positive likelihood ratio (LR+)) using diagnosis by a rheumatologist as an external standard. For secondary analyses, fulfilment of the Assessment in SpondyloArthritis international Society (ASAS) axSpA criteria was used as an external standard.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 107\/261 patients were diagnosed with axSpA. Most models performed well regarding sensitivity and specificity. The MASTER strategy showed a balanced sensitivity\/specificity with the highest LR+. The ASAS and Brandt I strategies are the most sensitive strategies. Using classification by ASAS axSpA criteria as the external standard gave comparable results. Most patients missed by the strategies fulfilled the imaging arm of the ASAS axSpA criteria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Most referral models performed well, although patients in SPACE have already been referred, which may have led to overestimation of performance. If no patient is to be missed, the ASAS strategy would be most preferable. If the number of referrals needs to be limited, the MASTER strategy seems to perform best. The \u2018ideal\u2019 referral strategy may be different from country to country, due to differences in healthcare structure and prevalence of referral parameters such as human leucocyte antigen-B27.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2016-000389","type":"journal-article","created":{"date-parts":[[2017,4,7]],"date-time":"2017-04-07T20:40:32Z","timestamp":1491597632000},"page":"e000389","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Evaluation of multiple referral strategies for axial spondyloarthritis in the SPondyloArthritis Caught Early (SPACE) cohort"],"prefix":"10.1136","volume":"3","author":[{"given":"Ozair","family":"Abawi","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaline","family":"van den Berg","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D\u00e9sir\u00e9e","family":"van der Heijde","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Floris A","family":"van Gaalen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,4,7]]},"reference":[{"key":"2025090312135231000_3.1.e000389.1","doi-asserted-by":"publisher","DOI":"10.1007\/s00296-002-0237-4"},{"key":"2025090312135231000_3.1.e000389.2","doi-asserted-by":"publisher","DOI":"10.1097\/BOR.0b013e328352e0ee"},{"key":"2025090312135231000_3.1.e000389.3","first-page":"1669","article-title":"Frequency of axial spondyloarthritis diagnosis among patients seen by United States rheumatologists for evaluation of chronic back pain","volume":"68","author":"Deodhar","year":"2016","journal-title":"Curr Opin Rheumatol"},{"key":"2025090312135231000_3.1.e000389.4","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2012.39"},{"key":"2025090312135231000_3.1.e000389.5","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.016386"},{"key":"2025090312135231000_3.1.e000389.6","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.139667"},{"key":"2025090312135231000_3.1.e000389.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-203201"},{"key":"2025090312135231000_3.1.e000389.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207596"},{"key":"2025090312135231000_3.1.e000389.9","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/j.jbspin.2014.02.008","article-title":"Spondyloarthritis: a window of opportunity?","volume":"81","author":"Claudepierre","year":"2014","journal-title":"Jt Bone Spine"},{"key":"2025090312135231000_3.1.e000389.10","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2004.028753"},{"key":"2025090312135231000_3.1.e000389.11","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204005"},{"key":"2025090312135231000_3.1.e000389.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.semarthrit.2014.10.009"},{"key":"2025090312135231000_3.1.e000389.13","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e3182514093"},{"key":"2025090312135231000_3.1.e000389.14","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204428"},{"key":"2025090312135231000_3.1.e000389.15","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2474-11-144"},{"key":"2025090312135231000_3.1.e000389.16","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131293"},{"issue":"2","key":"2025090312135231000_3.1.e000389.17","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1136\/annrheumdis-2015-eular.2983","article-title":"Assessing the best referral strategy for axial spondyloarthritis: several referral strategies evaluated in primary care patients with chronic low back","volume":"74","author":"Van Hoeven","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"2025090312135231000_3.1.e000389.18","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket164"},{"key":"2025090312135231000_3.1.e000389.19","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2009.108233"},{"key":"2025090312135231000_3.1.e000389.20","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.068734"},{"key":"2025090312135231000_3.1.e000389.21","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kep119"},{"key":"2025090312135231000_3.1.e000389.22","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110070"},{"key":"2025090312135231000_3.1.e000389.23","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.151167"},{"key":"2025090312135231000_3.1.e000389.24","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-201777"},{"key":"2025090312135231000_3.1.e000389.25","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/ket115"},{"key":"2025090312135231000_3.1.e000389.26","doi-asserted-by":"publisher","DOI":"10.1002\/acr.22180"},{"key":"2025090312135231000_3.1.e000389.27","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-207151"},{"key":"2025090312135231000_3.1.e000389.28","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.011247"},{"key":"2025090312135231000_3.1.e000389.29","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/34.11.1074"},{"key":"2025090312135231000_3.1.e000389.30","doi-asserted-by":"publisher","DOI":"10.1136\/ard.62.6.519"},{"key":"2025090312135231000_3.1.e000389.31","first-page":"2403","article-title":"Agreement between clinical practice and trained central reading in reading of sacroiliac joints on plain pelvic radiographs. Results from the DESIR Cohort","volume":"66","author":"Van Den Berg","year":"2014","journal-title":"Ann Rheum Dis"},{"key":"2025090312135231000_3.1.e000389.32","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205432"},{"key":"2025090312135231000_3.1.e000389.33","doi-asserted-by":"crossref","first-page":"1633","DOI":"10.1007\/s10067-012-2058-5","article-title":"Early diagnosis and treatment of ankylosing spondylitis in Africa and the Middle East","volume":"31","author":"Rachid","year":"2012","journal-title":"Clin Rheumatol"},{"key":"2025090312135231000_3.1.e000389.34","doi-asserted-by":"publisher","DOI":"10.1097\/RHU.0b013e3181637a38"},{"key":"2025090312135231000_3.1.e000389.35","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2008.101501"},{"key":"2025090312135231000_3.1.e000389.36","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2010.130559"},{"key":"2025090312135231000_3.1.e000389.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.reuma.2012.06.013"},{"key":"2025090312135231000_3.1.e000389.38","doi-asserted-by":"crossref","first-page":"1397","DOI":"10.1007\/s10067-014-2768-y","article-title":"Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis","volume":"34","author":"Seo","year":"2014","journal-title":"Clin Rheumatol"},{"key":"2025090312135231000_3.1.e000389.39","doi-asserted-by":"crossref","first-page":"e69","DOI":"10.1136\/annrheumdis-2015-208553","article-title":"Defining an optimal referral strategy for patients with a suspicion of axial spondyloarthritis: what is really important? Response to: \u2018evaluating the ASAS recommendations for early referral of axial spondyloarthritis in patients with chronic low back pain; is one parameter present sufficient for primary care practice?\u2019 by van Hoeven et al","volume":"74","author":"Poddubnyy","year":"2015","journal-title":"Ann Rheum Dis"},{"key":"2025090312135231000_3.1.e000389.40","doi-asserted-by":"publisher","DOI":"10.1136\/rmdopen-2015-000152"},{"key":"2025090312135231000_3.1.e000389.41","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1007\/s10067-014-2551-0","article-title":"Comparison of rates of referral and diagnosis of axial spondyloarthritis before and after an ankylosing spondylitis public awareness campaign","volume":"33","author":"Harrison","year":"2014","journal-title":"Clin Rheumatol"},{"key":"2025090312135231000_3.1.e000389.42","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1186\/s12891-015-0853-2","article-title":"The prevalence of axial spondyloarthritis in the UK: a cross-sectional cohort study","volume":"16","author":"Hamilton","year":"2015","journal-title":"BMC Musculoskelet Disord"}],"container-title":["RMD Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rmdopen-2016-000389","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T19:14:00Z","timestamp":1756926840000},"score":1,"resource":{"primary":{"URL":"https:\/\/rmdopen.bmj.com\/lookup\/doi\/10.1136\/rmdopen-2016-000389"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4]]},"references-count":42,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,4,7]]},"published-print":{"date-parts":[[2017,4]]}},"alternative-id":["10.1136\/rmdopen-2016-000389"],"URL":"https:\/\/doi.org\/10.1136\/rmdopen-2016-000389","relation":{},"ISSN":["2056-5933"],"issn-type":[{"value":"2056-5933","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,4]]}}}