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Research article
Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.
Christopher Burton
University of Sheffield
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0233-2431
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Background Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.
Methods Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms.
We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis.
Results Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 12.7, 95% CI 4.7 to 34.6); the occurrence of axial pain with and tendon symptoms within the same year (OR 21.7, 95% CI 2.6 to 181.5); and the co-occurrence (within 30 days) of axial pain and a prescription for nonsteroidal anti-inflammatory drug (OR 10.4, 95%CI 4.9 to 22.1). Coded episodes of axial pain increased steadily over the three years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis.
Conclusions We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.
Keywords
Ankylosing Spondylitis, Diagnosis, Primary Care, Electronic Health Records,
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Posted 14 Apr, 2020
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Editor assigned
On 08 Apr, 2020
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On 07 Apr, 2020
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On 07 Apr, 2020
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Editorial decision: Minor revision
On 04 Apr, 2020
Editor assigned
On 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
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Editorial decision: Major revision
On 19 Feb, 2020
Review #2 received
Received 18 Feb, 2020
Review #1 received
Received 28 Jan, 2020
Reviewer #2 agreed
On 23 Jan, 2020
Reviewer #1 agreed
On 03 Jan, 2020
Reviewers invited
Invitations sent on 28 Nov, 2019
Editor assigned
On 27 Nov, 2019
Submission checks complete
On 26 Nov, 2019
Editor invited
On 26 Nov, 2019
No comments provided
Editorial decision: Revise before sending to peer reviewers
On 12 Nov, 2019
Editor assigned
On 07 Nov, 2019
Submission checks complete
On 06 Nov, 2019
Editor invited
On 06 Nov, 2019
First submitted
On 05 Nov, 2019
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Subject Areas
General Practice
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This preprint is under consideration at BMC Family Practice. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.
Christopher Burton
University of Sheffield
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0233-2431
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 4
Posted 14 Apr, 2020
No community comments so far
Editor assigned
On 08 Apr, 2020
Submission checks complete
On 07 Apr, 2020
Editor invited
On 07 Apr, 2020
No comments provided
Editorial decision: Minor revision
On 04 Apr, 2020
Editor assigned
On 31 Mar, 2020
Submission checks complete
On 30 Mar, 2020
Editor invited
On 30 Mar, 2020
No comments provided
Editorial decision: Major revision
On 19 Feb, 2020
Review #2 received
Received 18 Feb, 2020
Review #1 received
Received 28 Jan, 2020
Reviewer #2 agreed
On 23 Jan, 2020
Reviewer #1 agreed
On 03 Jan, 2020
Reviewers invited
Invitations sent on 28 Nov, 2019
Editor assigned
On 27 Nov, 2019
Submission checks complete
On 26 Nov, 2019
Editor invited
On 26 Nov, 2019
No comments provided
Editorial decision: Revise before sending to peer reviewers
On 12 Nov, 2019
Editor assigned
On 07 Nov, 2019
Submission checks complete
On 06 Nov, 2019
Editor invited
On 06 Nov, 2019
First submitted
On 05 Nov, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
General Practice
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background Ankylosing spondylitis (AS) often has a long period from first symptom presentation to diagnosis. We examined the occurrence of symptoms, prescriptions and diagnostic tests in primary care electronic records over time prior to a diagnosis of AS.
Methods Nested case-control study using anonymised primary care electronic health records from Scotland. Cases were 74 adults with a first diagnosis of AS between 2000 and 2010. Controls were matched for age, sex and GP practice: (a) 296 randomly selected adults (b) 169 adults whose records contained codes indicating spinal conditions or symptoms.
We extracted clinical features (symptoms, AS-related disorders, prescriptions and diagnostic tests). Conditional logistic regression was used to examine the association between clinical features (both individually and in combinations) and diagnosis of AS. We examined the associations between clinical features and diagnosis over time prior to diagnosis.
Results Several new composite pointers were predictive of AS: including distinct episodes of axial pain separated by more than 6 months (OR 12.7, 95% CI 4.7 to 34.6); the occurrence of axial pain with and tendon symptoms within the same year (OR 21.7, 95% CI 2.6 to 181.5); and the co-occurrence (within 30 days) of axial pain and a prescription for nonsteroidal anti-inflammatory drug (OR 10.4, 95%CI 4.9 to 22.1). Coded episodes of axial pain increased steadily over the three years before diagnosis. In contrast, large joint symptoms and enthesopathy showed little or no time trend prior to diagnosis.
Conclusions We identified novel composite pointers to a diagnosis of AS in GP records. These may represent valuable targets for diagnostic support systems.
Figure 1
Figure 2