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Accelerating diagnosis of axial spondyloarthritis

What you need to know

Some people with persistent low back pain may have axial spondyloarthritis, a form of inflammatory arthritis that should be assessed by a rheumatologist for timely care. But, it can take several painful years to reach this diagnosis. In 2021, a clinical research group reported that a new model of care could effectively bridge this gap by having people with symptoms be rapidly screened by an advanced practice physiotherapist before referral to a rheumatologist if needed.

What is this research about?

Axial spondyloarthritis is a form of inflammatory arthritis in the spine that leads to chronic low back pain. It often affects young adults. The inflammation can cause loss of function and irreversible damage, and early treatment can improve outcomes. Unfortunately, previous studies have found that diagnosing axial spondyloarthritis as the cause of low back pain can sometimes take many years, due in part to non-specific symptoms and long wait times to be seen by a rheumatologist.

What did the researchers do?

Dr. Raja Rampersaud and colleagues developed a new model of care for low back pain assessment in Ontario. After people with persistent low back pain presented to a primary care clinic, they were assessed and screened for axial spondyloarthritis in two stages by physiotherapists certified with advanced training in arthritis care. People found to be at risk of axial spondyloarthritis were then presented to a rheumatologist for a final diagnosis. This study observed more than 400 patients and evaluated the accuracy of the advanced practice physiotherapists’ assessments, and whether this model of care shortened time to diagnosis.

What did they find?

The study showed that implementing this model of care – where rheumatologists collaborate with other healthcare professionals with advanced training in arthritis – shortened wait times to see a rheumatologist and accelerated accurate diagnosis for people with low back pain due to axial spondyloarthritis. The skilled physiotherapists were able to accurately divert people with low risk to other follow-up care while appropriately referring those at higher risk to rheumatology.

How can this research be used?

This study provides evidence to support the continued implementation of this model of care and its possible adaptation for additional settings and arthritis types. By leveraging interprofessional collaboration during the screening and referral process to support primary care providers and identify at-risk patients, this model could help counteract the shortage of rheumatologists experienced across Canada.

This new model of care is exciting and much needed. It can take people with axial spondyloarthritis years to be diagnosed, with women taking even longer than men. The earlier treatment can begin, the better the outcome, so any tool that can help accelerate diagnosis is welcome. I love that this model of care involves interprofessional collaboration and that it promises early diagnosis to save people (often young adults) years of pain and mental distress.”

— Michael Mallinson, patient partner

What impact could this have?

This model of care could reduce the time between low back pain onset to diagnosis by years. Not only will that greatly improve quality of life for people living with the pain of axial spondyloarthritis, especially in the prime of young adulthood, but it will also relieve pressure on the health system both in primary care and rheumatology.

About the researcher

Dr. Raja Rampersaud is a professor at the University of Toronto and a clinician-scientist at the University Health Network. His research on interprofessional model of care for screening and referral for low back pain for axial spondyloarthritis was supported by an Arthritis Society Canada Strategic Operating Grant awarded in 2014. Dr. Rampersaud also volunteers as an advisor on the Arthritis Society Canada’s Integrated Scientific and Medical Advisory Committee.

“As demonstrated for addressing timely access and appropriate referrals to spine surgeons and now rheumatologists, our networked interprofessional model has proven to be an effective bridge between primary care and specialty musculoskeletal care.”

— Dr. Raja Rampersaud, University Health Network
Photography of Dr. Raja Rampersaud

Publication citation

Passalent L, Sundararajan K, Perruccio AV, Hawke C, Coyte PC, Bombardier C, Bloom JA, Haroon N, Inman RD, Rampersaud YR. Bridging the gap between symptom onset and diagnosis in axial spondyloarthritis. Arthritis Care Res (Hoboken). 2021 Jul 15. doi: 10.1002/acr.24751. Online ahead of print.

Research at the Arthritis Society Canada

Through the trust and support of our donors and partners, Arthritis Society Canada is Canada’s largest charitable funder of cutting-edge arthritis research, investing over $220 million in research projects since our founding. These projects have led to breakthroughs in the diagnosis, treatment and care of people with arthritis. Visit us at