Enhancing diagnostic accuracy in axial spondyloarthritis through centralised clinical and imaging evaluation: results from a prospective multicentre project.

Abstract

The objective of this study was to evaluate the impact of centralised clinical and imaging case evaluation on the diagnostic assessment of patients with suspected axial spondyloarthritis (axSpA). We established a central telemedicine platform that allowed the collection of clinical and imaging information from patients who presented to rheumatologists and orthopaedists with suspicion of axSpA. Collected information included the suspected diagnosis, demographic, clinical, laboratory, and imaging data relevant for the diagnosis. Remote central expert evaluation comprised a detailed review of the submitted clinical and imaging data, followed by an expert diagnostic conclusion on the presence or absence of axSpA. A total 969 cases of suspected axSpA were evaluated. Based on the local assessment, 264 of 969 patients (27.2%) were diagnosed with axSpA. After central review, axSpA was considered present in 238 (24.6%) cases overall. Among patients with a local diagnosis of axSpA, 142 (53.8%) were considered axSpA also by central evaluation; however, in 89 (33.7%), an alternative cause of back pain-most commonly degenerative or mechanical disorders-was considered more likely. In comparison, among 319 patients locally assessed as not having axSpA, 265 (83.1%) were considered as no axSpA by central reviewers. One of the main drivers of the discrepancy between local and central diagnostic assessment was the interpretation of imaging findings as indicative of axSpA or not. Remote evaluation of clinical and imaging information by assessors with expertise in axSpA may support the diagnostic process in patients with suspected axSpA and help reduce the risk of misdiagnosis.