Diagnosis and treatment of spinal osteoarthritis in patients with back pain

Background
Back pain represents the first world leading cause of disability and a substantial burden to health care systems and society.
The large majority of patients with back pain are labeled as having ‘non-specific’ back pain, meaning that a specific cause cannot be established. However, within this group, there may be different subgroups of patients, e.g. those with symptomatic spinal osteoarthritis, who may respond differently to different treatments. Due to the lack of agreed diagnostic criteria for spinal osteoarthritis, it remains unclear how and when back pain is diagnosed as spinal osteoarthritis.

Hypothesis
A fundamental first step to improve diagnosis and treatment of patients with spinal osteoarthritis is to establish a simple, agreed and empirically based definition of spinal OA to be used in clinical and research practice.

Methods
This projects largely consists of 2 parts:

Part 1 – Development of criteria for symptomatic spinal OA

• Systematic review of studies describing the association between clinical findings and the presence of lumbar spine osteoarthritis imaging features.
• Based on the results of the systematic review and of a consensus-based study, a set of criteria will be selected and tested empirically against structural definitions of spinal OA to evaluate their diagnostic accuracy, using data from BACE, CHECK, the Rotterdam study and/or other available international datasets.
• Patients meeting the clinical criteria for spinal OA will be identified in the BACE cohort study and their prognostic trajectory over 5 years will be outlined and compared to the trajectory of patients with back pain but no spinal OA.

Part 2 – Spinal OA in general practice

• An online survey will be sent to general practitioners to explore the clinical criteria they use to assign the code L84 (spinal osteoarthritis) to patients with back pain.
• The Rijnmond Gezond database will be used to retrieve patients with the code L84 to provide a descriptive summary of diagnostic (e.g. imaging) and therapeutic (e.g. medications) interventions prescribed to these patients by general practitioners in the Netherlands.
• Semi-structured focus groups will be used to explore general practitioners’ opinion on the relevance of spinal OA in clinical practice. Additionally, the general practitioners will be presented the newly developed diagnostic criteria (part 1) to discuss whether their perspective on these criteria and on whether they would be willing to make a change in how they diagnose the presence of spinal OA in patients with back pain.

Primary outcome
Our primary goal is to establish new diagnostic criteria to be used in primary care to identify patients with back pain and spinal osteoarthritis and to investigate the prognostic course of these patients.

Secondary outcome
The second main goal is to make a first fundamental step towards a better clinical management of these patients, by providing a framework of general practitioners’ perspective on spinal OA, on the current clinical management of these patients and on whether the new diagnostic criteria can be implemented in clinical practice.

SBOH

Dr. Alessandro Chiarotto (co-promotor), a.chiarotto@erasmusmc.nl
Drs. Mirna Chamoro, m.chamoro@erasmusmc.nl
Dr. Evelien de Schepper, e.deschepper@erasmusmc.nl
Prof. Dr. Patrick Bindels, p.bindels@erasmusmc.nl
Prof. Sita Bierma-Zeinstra (promotor), s.bierma-zeinstra@erasmusmc.nl
Prof. Bart Koes (promotor), b.koes@erasmusmc.nl

Contact addresses for the project: m.chamoro@erasmusmc.nl and a.chiarotto@erasmusmc.nl.