primary care

Management of Shoulder Pain in Primary Care

Nathan Hinkle — Fri, 09 Oct 2026 05:00:00 +0000

Date Added:

October 9, 2026

Journal/Publication:

JAMA Intern Med

Publisher:

Journal of the American Medical Society

Publication Date:

August 17, 2026

Issue:

Volume:

186

Pages:

1256-1268

URL:

Management of Shoulder Pain in Primary Care A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

doi:10.1001/jamainternmed.2026.3135

Keywords

Shoulder Pain

primary care

soft-tissue disorders

MeSH

RPR Commentary: Guidance regarding when to refer patients with shoulder pain (and when not to). James W. Mold, MD, MPH

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Importance Shoulder pain is a common and disabling condition most often managed in primary care. This review provides an evidence-based update on the diagnosis and management of shoulder pain to support clinical decision-making and improve patient outcomes.

Observations Shoulder pain arises from benign, self-limiting soft-tissue disorders or rare but serious causes. In primary care, most cases are nontraumatic and involve periarticular soft tissues. The subacromial region is the most frequent source of pain, and the term subacromial pain is preferred over overlapping and inconsistently defined labels such as rotator cuff tendinopathy or tear, impingement syndrome, or subacromial bursitis. Less commonly, pain originates from the glenohumeral joint, as in glenohumeral osteoarthritis or adhesive capsulitis. Assessment should focus on a detailed history and physical examination to assess pain patterns and movement limitation and to exclude serious causes, such as infection, malignant neoplasm, or nonshoulder referred pain. Once these are excluded, first-line treatment is similar for most patients and aligns with recommended care for other regional musculoskeletal concerns: education about the favorable natural history, symptom relief and activity modification if needed, and watchful waiting. Early imaging is not indicated in the absence of significant trauma or suspicious features, such as fever, unexplained weight loss, or history of malignant neoplasm, as structural abnormalities often do not correlate with symptoms, rarely alter management, and may lead to overdiagnosis and overtreatment. Specialist referral should be reserved for suspected serious pathology, such as infection, malignant neoplasm, fracture, or dislocation; significant functional or neurologic deficit; features suggestive of systemic inflammatory disease; or persistent or worsening pain and debility. High-certainty evidence indicates that subacromial pain does not benefit from surgical intervention.

Conclusions and Relevance Shoulder pain is the third most common musculoskeletal presentation in primary care. Although causes vary, the initial management is largely the same once serious conditions have been excluded. Most patients with subacromial pain will fully recover with minimal intervention and can be safely treated with supportive care. Imaging and referral to surgical subspecialists should be reserved for rare and carefully selected cases to avoid unnecessary intervention.

Author/s:

Romi Haas, Thomas Ibounig, Rachelle Buchbinder

Management of Shoulder Pain in Primary Care: A Review

Mary Cervantes — Wed, 19 Aug 2026 17:54:00 +0000

Date Added:

August 19, 2026

Journal/Publication:

JAMA Internal Medicine

Publisher:

JAMA Intern Med

Publication Date:

August 17, 2026

URL:

Management of Shoulder Pain in Primary Care: A Review

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2026.3135

Keywords

Internal Medicine

Internal Medicine Practice

MeSH

clinical decision-making

Physical Examination

Physical Examination / methods

Overtreatment

primary health care

referral and consultation

Tendinopathy

A review of the management of patients with shoulder pain. James W. Mold, MD, MPH

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Author/s:

Romi Haas, Thomas Ibounig, MD, Buchbinder, Rachelle

Management of Shoulder Pain in Primary Care

Mary Cervantes — Wed, 19 Aug 2026 17:36:50 +0000

Date Added:

August 19, 2026

Journal/Publication:

JAMA Internal Medicine

Publisher:

JAMA, JAMA Network, JN Learning, AMA Ed Hub

Publication Date:

August 17, 2026

URL:

Management of Shoulder Pain in Primary Care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Video

Keywords

MeSH

Physical Therapy Modalities

primary health care

A 15-minute audio-review of the management of shoulder pain in primary care. James W. Mold, MD, MPH

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From the JAMA Network, this is JAMA Internal Medicine Author Interviews. Conversations with authors exploring the latest clinical research, reviews, and opinions featured in JAMA Internal Medicine.

Author/s:

Romi Haas, MPH, PhD, Michael A. Incze, Eve Rittenberg, MD

Radial Sided Wrist Pain: First Line Diagnostic Approach and Management of Selected Common Pathologies

Nathan Hinkle — Tue, 04 Aug 2026 19:37:28 +0000

Date Added:

August 4, 2026

Journal/Publication:

Canadian Family Physician/Le Medecin De Famille Canadien

Publisher:

College of Family Physicians of Canada

Publication Date:

July 29, 2026

Issue:

7-8

Volume:

Pages:

458-465

URL:

Radial Sided Wrist Pain: First Line Diagnostic Approach and Management of Selected Common Pathologies

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.46747/cfp.720708458

Keywords

Wrist Pain

primary care

Diagnostic Approaach

MeSH

physicians, primary care

wrist

Diagnosis

diagnosis, differential

RPR Commentary: A review of the causes of radial-sided wrist pain. James W. Mold, MD, MPH

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Abstract
Objective To provide a clinical overview of selected common pathologies causing radial-sided wrist pain and to guide primary care physicians in the diagnostic approach and initial management of these conditions.

Sources of information A literature review was conducted using the PubMed MEDLINE database, supplemented by reference musculoskeletal clinical textbooks.

Main message Radial-sided wrist pain has a wide differential diagnosis due to the complex anatomy of the wrist. A thorough clinical evaluation—including detailed history, physical examination, and appropriate imaging—is essential for accurate diagnosis. Several common conditions are presented with diagnostic features, relevant physical examination tests, and an overview of treatment options.

Conclusion Radial-sided wrist pain requires careful clinical assessment to differentiate among multiple pathologies originating from anatomic causes. Primary care physicians can effectively manage many of these conditions with appropriate diagnostic strategies and conservative treatments. Early recognition and targeted interventions can prevent complications and improve patient outcomes.

Musculoskeletal concerns account for about one-fifth to one-quarter of all primary care visits.1,2 Among those, hand and wrist concerns account for 47 to 60 cases per 1000 patients per year.3 Given the large number of anatomic structures in the relatively small volume of the wrist, radial-sided wrist pain can present a diagnostic challenge. We provide a clinical review of selected common hand and wrist pathologies affecting the radial side of the wrist, defined as the region from the distal radius to the mid-first volar and dorsal metacarpal to a line between the radius and ulna to the base of the second metacarpal.

Author/s:

Harris, Philipe, René Wittmer, Valois Emilie, Patrick G.

Hypertension and alcohol: a cross-sectional study comparing PEth with AUDIT and AUDIT-C in primary care

Megan George — Mon, 16 Feb 2026 17:36:14 +0000

Date Added:

February 16, 2026

Journal/Publication:

Family Practice

Publication Date:

February 1, 2026

URL:

Hypertension and alcohol: a cross-sectional study comparing PEth with AUDIT and AUDIT-C in primary care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1093/fampra/cmaf097

Keywords

alcohol use disorder

cardiovascular disorders

PMID (1):

41511884

MeSH

Alcohol Drinking* / epidemiology

Antihypertensive Agents / therapeutic use

lycerophospholipids* / blood

Hypertension* / drug therapy

Hypertension* / epidemiology

Alcoholism* / diagnosis

primary health care

The results of this study suggest that patients with poorly controlled BP should be further evaluated for alcohol use disorders even if the brief screening questions are negative. James W. Mold, MD, MPH

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Background: This cross-sectional study aimed to describe proportions of patients with indications of alcohol consumption using phosphatidylethanol (PEth), the Alcohol Use Disorders Identification Test (AUDIT), and its consumption-focused version (AUDIT-C), in relation to blood pressure (BP) control, overall and by sex.

Methods: A total of 270 hypertensive primary care patients (ICD-10: I10.9) were stratified into BP control groups: controlled (<140/90 mmHg), uncontrolled (≥140/90 mmHg), and apparent treatment-resistant hypertension (aTRH; ≥140/90 mmHg with ≥3 antihypertensive drugs). A randomized sample from each stratum was invited, baseline data were collected. Alcohol consumption using predefined categories for PEth and AUDIT, and hazardous use (PEth ≥ 0.122 µmol/L; AUDIT ≥ 8; AUDIT-C ≥ 5 for men, ≥4 for women), were analyzed in relation to BP control groups.

Results: Mean age was 67 ± 11 years; 42% were women. PEth indicated high and regular alcohol consumption in 6.4% of controlled, 5.3% of uncontrolled, and 19.2% of aTRH patients (controlled vs. aTRH, P = .027; uncontrolled vs. aTRH, P = .013). AUDIT showed no significant differences in hazardous use between BP groups (P = .865). AUDIT-C identified slightly higher proportions of hazardous use than PEth, across BP groups and sexes. No significant differences were found between BP groups for hazardous use by PEth (P = .339) or AUDIT-C (P = .150).

Conclusions: PEth revealed significantly higher alcohol use in the aTRH group, undetected by AUDIT. AUDIT-C and PEth identified more hazardous use than AUDIT, suggesting their potential to prompt alcohol-related discussions and support evidence-based hypertension care. PEth correlated more strongly with AUDIT-C than with AUDIT.

Clinical trial registration: Retrospectively registered in Clinical Trials, SLSO2022-0143, 2022-12-10.

Keywords: alcohol use disorder; cardiovascular disorders (hypertension/DVT/atherosclerosis); hypertension (high blood pressure); prevention; primary care; screening.

Author/s:

Åsa Thurfjell, Maria Hagströmer, Charlotte Ivarsson, Anders Norrman, Johanna Adami, Lena Lundh, Jan Hasselström

Uniting depression care through generalism: a primary care-informed response to the Lancet–World Psychiatric Association Commission’s call for action on depression

Megan George — Thu, 06 Nov 2025 14:44:00 +0000

Date Added:

November 6, 2025

Journal/Publication:

The Lancet

Publication Date:

October 9, 2025

URL:

Uniting depression care through generalism: a primary care-informed response to the Lancet–World Psychiatric Association Commission’s call for action on depression

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.lanprc.2025.100042

Keywords

MeSH

I thoughtful, evidence-based set of recommendations for improving the care of patients with depression in primary care settings. James W. Mold, MD, MPH

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In this Viewpoint, we respond to the 2022 Lancet–World Psychiatric Association Commission’s call for united action on depression. We present primary care-focused recommendations synthesised from key outcomes of 16 observational cohorts of adults with depression in primary care, representing more than 26 000 individuals from 26 countries. Identified areas for action included prediction of the depression severity trajectory, the complexity of the depressive experience, and the need for tailored yet holistic depression-care plans. Personal resilience and reductions in social burden were identified as powerful predictors of improved depression outcomes. Aimed at policy makers in primary care, researchers, and primary care providers, our recommendations emphasise a generalist model of care that is person focused and trauma informed. We advocate for increased primary care capacity for depression risk prediction, social support integration, care navigation, and continuity of care. By bridging the gap between primary care and psychiatric knowledge, our recommendations provide actionable guidance for reducing the global burden of depression.

Author/s:

Alison Flehr, Christopher Dowrick, Catherine Kaylor-Hughes, Jane Gunn

Epley manoeuvre’s efficacy for benign paroxysmal positional vertigo (BPPV) in primary-care and subspecialty settings: a systematic review and meta-analysis

Rowan Hutchins — Sat, 09 Dec 2023 06:00:00 +0000

Date Added:

December 9, 2023

Journal/Publication:

BMC Primary Care

Publisher:

BMC

Publication Date:

December 2, 2023

Issue:

262

Volume:

URL:

Epley manoeuvre’s efficacy for benign paroxysmal positional vertigo (BPPV) in primary-care and subspecialty settings: a systematic review and meta-analysis

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1186/s12875-023-02217-z

Keywords

epley maneuvers

primary care

Clinical

benign paroxysmal positional vertigo

PMID (1):

38042776

MeSH

Benign Paroxysmal Positional Vertigo* / diagnosis

Benign Paroxysmal Positional Vertigo* / therapy

General Practitioners*

hospitalization

Epley maneuvers performed in primary care settings may be just as effective as when performed in subspecialty settings. Primary care clinicians and their staffs should be equipped to perform this simple therapeutic technique. James W. Mold, MD, MPH

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Although previous studies have reported general inexperience with the Epley manoeuvre (EM) among general physicians, no report has evaluated the effect of EM on benign paroxysmal positional vertigo (BPPV) in primary care by using point estimates or certainty of evidence. We conducted this systematic review and meta-analysis and clarified the efficacy of EM for BPPV, regardless of primary-care and subspecialty settings.

Author/s:

Yusuke Saishoji, Norio Yamamoto, Takashi Fujiwara, Hideki Mori, Shunsuke Taito

Approach to nail trauma for primary care physicians

Rowan Hutchins — Mon, 02 Oct 2023 05:00:00 +0000

Date Added:

October 2, 2023

Journal/Publication:

Canadian Family Physician

Publisher:

College of Family Physicians of Canada

Publication Date:

September 1, 2023

Issue:

Volume:

Pages:

609-613

URL:

Approach to nail trauma for primary care physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.46747/cfp.6909609

Keywords

fingers

nails

primary care

PMID (1):

37704235

MeSH

Fractures

Bone* / therapy

Nail Diseases* / diagnosis

Nail Diseases* / therapy

A review of the proper evaluation and care of patients with fingernail injuries. James W. Mold, MD, MPH

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Objective: To provide an overview and approach to common nail bed injuries seen by primary care practitioners.

Sources of information: An Ovid MEDLINE literature search was performed using search terms and studies were graded based on level of evidence.

Main message: Nail trauma is common in primary care practice and requires proper and prompt treatment to avoid lasting effects on finger function and cosmesis. When presented with a fingernail injury, primary care physicians should perform a thorough physical examination to determine extent of injury; take a history to rule out notable risk factors; perform a comprehensive neurovascular examination to assess pulp capillary refill, to do a 2-point discrimination, and to compare with an uninjured digit; and evaluate range of motion. Clinical evaluation may require local anesthesia and a tourniquet. Nail bed trauma can present in different ways and includes subungual hematomas, distal phalanx fractures, Seymour fractures, and-in more severe cases-fragmentation or avulsion of the nail bed. Treatment for subungual hematomas where the nail plate is intact does not require nail plate removal and nail bed exploration; however, exploration and repair are indicated for a nail plate injury, a proximal fracture involving the germinal matrix, and a distal phalanx fracture requiring stabilization.

Conclusion: Fingertips are essential to normal hand function. Nail trauma is common and can be managed by primary care physicians. Shared decision making concerning management is based on the mechanism and extent of the injury and aims to prevent secondary deformities.

Author/s:

Knox, Aaron, Lafreniere, Ann-Sophie, Misati , Griffins

Screening for primary aldosteronism in primary care

Aubrey Delammermore — Thu, 30 Mar 2023 05:00:00 +0000

Date Added:

March 30, 2023

Journal/Publication:

Canadian Medical Association Journal

Publisher:

CMA Impact

Publication Date:

March 20, 2023

Issue:

Volume:

195

Pages:

E410

URL:

Screening for primary aldosteronism in primary care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.221466

Keywords

Hypokalemia

Aldosterone

primary aldosteronism

MeSH

Mineralocorticoid Receptor Antagonists

Aldosterone

Angiotensin-Converting Enzyme Inhibitors

A very concise review of the suspicion, detection, and management of hyperaldosteronism in patients with hypertension. James W. Mold, MD, MPH

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Primary aldosteronism (PA) is common among patients with hypokalemia and hypertension. Patients with PA are at an increased risk of chronic disease if undiagnosed or untreated. Expert consensus recommends screening for PA in high-risk populations. Most antihypertensive medications can be continued during the work-up for PA. An elevated aldosterone-to-renin ratio is suggestive of PA.

Author/s:

Dubrofsky, L., Hundemer, G. L.

Women’s health update: A literature review impacting primary care

Aubrey Delammermore — Thu, 21 Jul 2022 05:00:00 +0000

Date Added:

July 21, 2022

Journal/Publication:

Cleveland Clinic Journal of Medicine

Publisher:

The Cleveland Clinic Foundation

Publication Date:

July 1, 2022

Issue:

Volume:

Pages:

373-381

URL:

Women’s health update: A literature review impacting primary care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.3949/ccjm.89a.21123

Keywords

Women's Health

primary care

Literature Review

Internal Medicine Practice

Disease Risks

PMID (1):

35777837

MeSH

A case-based review of a variety of common women’s health issues. James W. Mold, MD, MPH

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The authors review studies on key issues in women’s health with potential impact on internal medicine practice. The reviewed articles discuss cardiovascular disease risks, bone health, breast cancer genetics, cervical cancer prevention, depression in the peripartum period, pelvic pain, and emergency contraception.

Author/s:

Dolan, B. M., Merriam, S., Prifti, C. A., Walsh, J. M.

Evaluation of a Chronic Pain Screening Program Implemented in Primary Care

Saige Blanchard — Fri, 06 Aug 2021 05:00:00 +0000

Date Added:

August 6, 2021

Journal/Publication:

Journal of the American Medical Association

Publisher:

JAMA

Publication Date:

July 1, 2021

Issue:

Volume:

URL:

Evaluation of a Chronic Pain Screening Program Implemented in Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1001/jamanetworkopen.2021.18495

Keywords

PMID (1):

34313738

MeSH

Cross-Sectional Studies

Activities of Daily Living

chronic pain

Pleasure

Pain Measurement

Electronic Health Records

It is possible to screen for chronic pain using two questions. One-third of patients being seen in community health centers have chronic pain. In 40% of them the problem had not been previously identified. James W. Mold, MD, MPH

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Importance: Although pain is among the most common symptoms reported by patients, primary care practitioners (PCPs) face substantial challenges identifying and assessing pain.

Objective: To evaluate a 2-step process for chronic pain screening and follow-up in primary care.

Design, setting, and participants: A cross-sectional study of patients with a primary care visit between July 2, 2018, and June 1, 2019, was conducted at a statewide, multisite federally qualified health center. Participants included 68 PCPs and 58 medical assistants from 13 sites who implemented the screening process in primary care, and 38 866 patients aged 18 years or older with a primary care visit during that time.

Exposures: Single-question assessment of pain frequency, followed by a 3-question PEG (pain, enjoyment of life, general activity) functional assessment for patients with chronic pain.

Main outcomes and measures: Adherence to a 2-step chronic pain screening and PEG process, proportion of patients with positive screening results, mean PEG pain severity greater than or equal to 7, and documented chronic painful condition diagnosis in patient's electronic health record between 1 year before and 90 days after screening.

Results: Of 38 866 patients with a primary care visit, 31 600 patients (81.3%) underwent screening. Mean (SD) age was 46.2 (15.4) years, and most were aged 35 to 54 years (12 987 [41.1%]), female (18 436 [58.3%]), Hispanic (14 809 [46.9%]), and English-speaking (22 519 [71.3%]), and had Medicaid insurance (18 442 [58.4%]). A total of 10 262 participants (32.5%) screened positive and, of these, 9701 (94.5%) completed the PEG questionnaire. PEG responses indicated severe pain interference with activities of daily living (PEG ≥7) in 5735 (59.1%) participants. A chronic painful condition had not been diagnosed in 4257 (43.9%) patients in the year before screening. A new chronic painful condition was diagnosed at screening or within 90 days in 2250 (52.9%) patients. Care teams found the workflow acceptable, but cited lengthy administration time, challenges with comprehension of the PEG questions, and limited comprehensiveness as implementation barriers.

Conclusions and relevance: A systematic, 2-step process for chronic pain screening and functional assessment in primary care appeared to identify patients with previously undocumented chronic pain and was feasible to implement. Patient-provided information on the frequency of pain, pain level, and pain interference can help improve the assessment and monitoring of pain in primary care.

Author/s:

Bifulco, L., Anderson, D. R., Blankson, M. L, Channamsetty, V., Blaz, J. W., Nguyen-Louie, T., Scholle, S. H.

IDENTIFYING AND ADDRESSING SOCIAL NEEDS IN PRIMARY CARE SETTINGS

Saige Blanchard — Wed, 23 Jun 2021 05:00:00 +0000

Date Added:

June 23, 2021

Publisher:

Agency for Healthcare Research and Quality

URL:

IDENTIFYING AND ADDRESSING SOCIAL NEEDS IN PRIMARY CARE SETTINGS

Type:

Practice Management Reviews and Guidelines

Format:

Web Page

Keywords

social needs

primary care

SDOH

social determinants of health

MeSH

social determinants of health

Ambulatory Care Facilities

primary health care

Homeless Persons

This is a toolkit for practices that want to screen for and address social determinants of health. James W. Mold, MD, MPH

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Social determinants of health (SDOH) are widely recognized as having an important impact on health and
mortality,1 and there is now strong evidence of the benefits of addressing people’s unmet social needs.
For example, ensuring access to healthy foods and providing
supportive housing for people facing homelessness have been
found to lower healthcare utilization and costs.2 In addition, there
is emerging evidence that screening for and attempting to address
unmet needs within a primary care setting can improve patient
health.3 In response to this growing body of evidence, primary care
practices and health systems are increasingly integrating formal
screening for social needs into clinical care services.

Quick Guide to Primary Care First

Devin Evans — Wed, 24 Mar 2021 05:00:00 +0000

Date Added:

March 24, 2021

Publisher:

Center for Medicare and Medicaid Innovation

Publication Date:

February 18, 2021

URL:

Quick Guide to Primary Care First

Type:

Notifications and Opportunities

Format:

Slides

Keywords

MeSH

This appears to be an opportunity to test value-based purchasing for CMS. The due date for applications is May 28. James W. Mold, MD, MPH

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Primary Care First is a voluntary five-year payment model that rewards value and quality by offering an innovative payment structure to support advanced primary care delivery. Primary Care First aims to improve quality and access to care for all patients, particularly those with complex chronic conditions. The model also aims to reduce Medicare spending by preventing avoidable inpatient hospital admissions.

Author/s:

Primary Care First

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Devin Evans — Wed, 24 Feb 2021 06:00:00 +0000

Date Added:

February 24, 2021

Journal/Publication:

Journal of the American Medical Association Network Open

Publication Date:

February 1, 2021

Issue:

Volume:

URL:

Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2020.37371

Keywords

PMID (1):

33591367

MeSH

Patients with acute low back pain are more likely to progress to chronic low back pain if they are prescribed opioids or referred for imaging studies or subspecialists (after controlling for other risk factors). James W. Mold, MD, MPH

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Importance: Acute low back pain (LBP) is highly prevalent, with a presumed favorable prognosis; however, once chronic, LBP becomes a disabling and expensive condition. Acute to chronic LBP transition rates vary widely owing to absence of standardized operational definitions, and it is unknown whether a standardized prognostic tool (ie, Subgroups for Targeted Treatment Back tool [SBT]) can estimate this transition or whether early non-guideline concordant treatment is associated with the transition to chronic LBP.

Objective: To assess the associations between the transition from acute to chronic LBP with SBT risk strata; demographic, clinical, and practice characteristics; and guideline nonconcordant processes of care.

Design, setting, and participants: This inception cohort study was conducted alongside a multisite, pragmatic cluster randomized trial. Adult patients with acute LBP stratified by SBT risk were enrolled in 77 primary care practices in 4 regions across the United States between May 2016 and June 2018 and followed up for 6 months, with final follow-up completed by March 2019. Data analysis was conducted from January to March 2020.

Exposures: SBT risk strata and early LBP guideline nonconcordant processes of care (eg, receipt of opioids, imaging, and subspecialty referral).

Main outcomes and measures: Transition from acute to chronic LBP at 6 months using the National Institutes of Health Task Force on Research Standards consensus definition of chronic LBP. Patient demographic characteristics, clinical factors, and LBP process of care were obtained via electronic medical records.

Results: Overall, 5233 patients with acute LBP (3029 [58%] women; 4353 [83%] White individuals; mean [SD] age 50.6 [16.9] years; 1788 [34%] low risk; 2152 [41%] medium risk; and 1293 [25%] high risk) were included. Overall transition rate to chronic LBP at six months was 32% (1666 patients). In a multivariable model, SBT risk stratum was positively associated with transition to chronic LBP (eg, high-risk vs low-risk groups: adjusted odds ratio [aOR], 2.45; 95% CI, 2.00-2.98; P < .001). Patient and clinical characteristics associated with transition to chronic LBP included obesity (aOR, 1.52; 95% CI, 1.28-1.80; P < .001); smoking (aOR, 1.56; 95% CI, 1.29-1.89; P < .001); severe and very severe baseline disability (aOR, 1.82; 95% CI, 1.48-2.24; P < .001 and aOR, 2.08; 95% CI, 1.60-2.68; P < .001, respectively) and diagnosed depression/anxiety (aOR, 1.66; 95% CI, 1.28-2.15; P < .001). After controlling for all other variables, patients exposed to 1, 2, or 3 nonconcordant processes of care within the first 21 days were 1.39 (95% CI, 1.21-2.32), 1.88 (95% CI, 1.53-2.32), and 2.16 (95% CI, 1.10-4.25) times more likely to develop chronic LBP compared with those with no exposure (P < .001).

Conclusions and relevance: In this cohort study, the transition rate to chronic LBP was substantial

Author/s:

Stevans, Joel M., Delitto, Anthony, Khoja, Samannaaz, Patterson, Charity G., Smith, Clair N., Schneider, Michael J., Freburger, Janet K., Greco, Carol M., Freel, Jennifer A., Sowa, Gwendolyn A., Wasan, Ajay D., Brennan, Gerard P., Hunter, Stephen J., Minick, Kate I., Wegener, Stephen T., Ephraim, Patti L., Friedman, Michael", Jason M., Robert B.

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Devin Evans — Wed, 04 Nov 2020 06:00:00 +0000

Date Added:

November 4, 2020

Publisher:

Mayo Clinic Proceedings

Publication Date:

July 29, 2020

Issue:

Volume:

Pages:

2499-2508

URL:

Recognizing Axial Spondyloarthritis: A Guide for Primary Care

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2020.02.007

Keywords

back pain

Axial Spondyloarthritis

primary care

PMID (1):

32736944

MeSH

A systematic review of what we know currently about axial spondyloarthritis, formerly known as ankylosing spondylitis. James W. Mold, MD, MPH

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Axial spondyloarthritis (axSpA) is an important cause of chronic low back pain and affects approximately 1% of the US population. The back pain associated with axSpA has a characteristic pattern referred to as inflammatory back pain (IBP). Features of IBP include insidious onset before age 45 years, association with morning stiffness, improvement with exercise but not rest, alternating buttock pain, and good response to treatment with nonsteroidal anti-inflammatory drugs. In patients with IBP, it is essential to look for other features associated with spondyloarthritis (SpA), such as enthesitis, dactylitis, peripheral arthritis, extra-articular manifestations (eg, psoriasis, uveitis, or inflammatory bowel disease), human leukocyte antigen B27 positivity, and a family history of SpA. Axial SpA is underrecognized, and a delay of several years between symptom onset and diagnosis is common. However, with new and effective therapies available for the treatment of active axSpA, early recognition and diagnosis are of critical importance. For this narrative review, we conducted a literature search of English-language articles using PubMed. Individual searches were performed to identify potential articles of interest related to axSpA (search terms: ["axSpA" OR "axial SpA" OR "axial spondyloarthritis" OR "ankylosing spondylitis"]) in combination with terms related to IBP ("inflammatory back pain" OR "IBP" OR "chronic back pain" OR "CBP" OR "lower back pain" OR "LBP"), diagnosis (["diagn∗" OR "classification"] AND ["criteria" OR "recommend∗" OR "guidelines"]), and referral ("refer∗"). No date range was formally selected, as we were interested in providing an overview of the evolution of these concepts in clinical practice. We supplemented the review with insights based on our clinical expertise. Patients with chronic back pain should be screened for IBP and other SpA features; suspicion for axSpA should trigger referral to a rheumatologist for further evaluation.

Author/s:

Magrey, Marina N., Danve, Abhijeet S., Ermann, Joerg, Walsh, Jessica A.