TOPLINE:

A new screening tool, the A-tool, identified axial spondyloarthritis (axSpA) in more than 30% of patients with chronic back pain. The questionnaire tool showed varying sensitivity and specificity across individual questions, but its simplicity may promote widespread use without the need for specialized tests.

METHODOLOGY:

• Researchers conducted a single-center prospective study at Yale University to assess the effectiveness of a self-referral strategy in identifying axSpA in patients with chronic back pain.
• The A-tool, a clinical feature-based screening questionnaire, was used to identify potential cases of axSpA. It included three questions in the prescreen and eight in the screening questionnaire; the screening questionnaire focused on inflammatory back pain, enthesitis, peripheral arthritis, psoriasis, inflammatory bowel disease, uveitis, and spondyloarthritis family history.
• Patients with positive responses to all prescreen questions and to three or more screening questions in the A-tool underwent clinical evaluation, lab tests, and imaging studies to confirm diagnosis. Data on validated disease activity measures and functional indices for axSpA were collected, and patients were classified as either having axSpA or not having axSpA.
• The study assessed the sensitivity and specificity of the A-tool questions, with physicians’ judgments as the gold standard.
• Of the 100 participants aged 18-60 years recruited through an electronic health record portal or social media, 86 completed all study procedures.

TAKEAWAY:

• The A-tool identified axSpA in 34% of patients, including seven diagnosed with ankylosing spondylitis and 22 with nonradiographic axSpA.
• Patients suspected of having axSpA during clinical evaluation were more likely to be diagnosed with the condition (P = .0013), with a higher prevalence of HLA-B27 in the axSpA group than in the no-axSpA group (24% vs 3.5%; P = .0064). Among physician-confirmed responses, an affirmative response to the question regarding family history of SpA was associated with increased odds of axSpA diagnosis (odds ratio, 3.83; 95% CI, 1.39-11.4).
• Sensitivity of the A-tool questions ranged from 0.03 to 0.86, and specificity ranged from 0.14 to 0.96. The positive likelihood ratios of the A-tool items ranged from 0.84 to 1.34, and the area under the curve for the receiver operating characteristic curve was 0.66.
• The study found low-to-moderate agreement between patient responses on the A-tool and physician-confirmed responses, with kappa values ranging from 0.19 to 0.88.

IN PRACTICE:

“A-tool can be used to screen large population of CBP [chronic back pain] as it does not involve performing labs or imaging tests prior to referral. Incorporating digital technology, A-tool can be integrated into EMRs [electronic medical records], made available on various websites, or disseminated using social media. A-tool-based strategy can be used by patients themselves (self-referral) or administered by nonrheumatology providers,” the authors wrote.

SOURCE:

This study was led by Abhijeet Danve, MD, MHS, Yale School of Medicine in New Haven, Connecticut. It was published online on July 28, 2025, in Rheumatology Advances in Practice.

LIMITATIONS:

This study was a pilot study with a small sample size. Its exploratory nature meant that no multiple testing corrections were applied, thereby increasing the risk for type 1 errors. Low referral completion rates may have introduced selection bias, as fewer patients agreed to participate.

DISCLOSURES:

This study was supported by Novartis. One author disclosed receiving research grants and serving on advisory boards for various pharmaceutical companies, including Novartis and Eli Lilly.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.