Clinical features in primary care electronic records before diagnosis of ankylosing spondylitis: a nested case-control study

Abstract 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 100 adults with a first diagnosis of AS between 1994 and 2010. Controls were matched for age, sex and GP practice: (a) 400 randomly selected adults (b) 236 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 3.7, 95% CI 1.8 to 7.5) and the co-occurrence of axial pain with either large joint symptoms (OR 2.7, 95% CI 1.1 to 6.3) or tendon symptoms within the same year (OR 3.6, 95% CI 1.3 to 10.3). 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.

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Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

10.21203/rs.2.17268/v1 ◽

2019 ◽

Author(s):

Mohammed Talha Bashir ◽

Lisa Iversen ◽

Christopher Burton

Keyword(s):

Primary Care ◽

Clinical Features ◽

Diagnostic Tests ◽

Case Control Study ◽

Case Control ◽

Electronic Records ◽

Large Joint ◽

Axial Pain ◽

Nested Case Control ◽

Control Study

Abstract 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 100 adults with a first diagnosis of AS between 1994 and 2010. Controls were matched for age, sex and GP practice: (a) 400 randomly selected adults (b) 236 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 3.7, 95% CI 1.8 to 7.5) and the co-occurrence of axial pain with either large joint symptoms (OR 2.7, 95% CI 1.1 to 6.3) or tendon symptoms within the same year (OR 3.6, 95% CI 1.3 to 10.3). 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.

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Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

10.21203/rs.2.17268/v4 ◽

2020 ◽

Author(s):

Mohammed Talha Bashir ◽

Lisa Iversen ◽

Christopher Burton

Keyword(s):

Primary Care ◽

Clinical Features ◽

Diagnostic Tests ◽

Case Control Study ◽

Case Control ◽

Electronic Records ◽

Axial Pain ◽

Nested Case Control ◽

Control Study ◽

Over Time

Abstract 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.

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Clinical features in primary care electronic records before diagnosis of Ankylosing Spondylitis: a nested case-control study.

10.21203/rs.2.17268/v3 ◽

2020 ◽

Author(s):

Mohammed Talha Bashir ◽

Lisa Iversen ◽

Christopher Burton

Keyword(s):

Primary Care ◽

Clinical Features ◽

Diagnostic Tests ◽

Case Control Study ◽

Case Control ◽

Electronic Records ◽

Axial Pain ◽

Nested Case Control ◽

Control Study ◽

Over Time

Abstract 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.

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Ankylosing spondylitis and the risk of fracture: results from a large primary care-based nested case-control study

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.100503 ◽

2008 ◽

Vol 68 (12) ◽

pp. 1839-1842 ◽

Cited By ~ 110

Author(s):

D Vosse ◽

R Landewe ◽

D van der Heijde ◽

S van der Linden ◽

T-P van Staa ◽

...

Keyword(s):

Primary Care ◽

Ankylosing Spondylitis ◽

Case Control Study ◽

Case Control ◽

Risk Of Fracture ◽

Nested Case Control ◽

Large Primary ◽

Control Study

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Relation of therapies for ankylosing spondylitis and psoriatic arthritis to risk of myocardial infarction: a nested case control study

BMC Rheumatology ◽

10.1186/s41927-021-00207-1 ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Rachael Stovall ◽

Christine Peloquin ◽

David Felson ◽

Tuhina Neogi ◽

Maureen Dubreuil

Keyword(s):

Myocardial Infarction ◽

Psoriatic Arthritis ◽

Ankylosing Spondylitis ◽

Case Control Study ◽

Tumor Necrosis Factor Inhibitor ◽

The United States ◽

Case Control ◽

Geographical Regions ◽

Nested Case Control ◽

Control Study

Abstract Background Risk of myocardial infarction (MI) is elevated in ankylosing spondylitis and psoriatic arthritis (AS/PsA) compared to the general population. We evaluated the risk of MI related to the use of tumor necrosis factor inhibitor (TNFi) and other therapies in AS/PsA. Methods We conducted a nested case-control study using 1994–2018 data from OptumLabs® Data Warehouse, which includes de-identified medical and pharmacy claims, laboratory results, and enrollment records for commercial and Medicare Advantage enrollees. The database contains longitudinal health information on enrollees and patients, representing a diverse mixture of ages, ethnicities and geographical regions across the United States. Assessing AS/PsA separately, MI cases were matched to 4 controls by sex, age, diagnosis year and insurance type. We evaluated treatment within 6 months prior to MI including NSAIDs (AS referent), disease-modifying anti-rheumatic drug (DMARDs; PsA referent) and TNFi alone or in combinations. We evaluated the relation of treatment categories to MI risk using conditional logistical regression adjusting for confounders. Results Among 26,648 AS subjects, there were 237 MI cases and 894 matched controls. Among 43,734 PsA subjects, there were 404 cases and 1596 controls. In AS, relative to NSAID use, the adjusted odds ratio (aOR) for MI among TNFi only users was 0.85 (95% CI 0.39–1.85) and for DMARD only users was 1.04 (95% CI 0.65–1.68). In PsA, relative to DMARD use, the aOR among TNFi only was 1.09 (95% CI 0.74–1.60). Combination therapies also had no effect. Conclusions Among AS/PsA, no combination of therapies appeared to be protective or harmful with regards to MI. Future studies should capture more AS and PsA patients and include longer term follow up to further investigate this question.

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Association between opioid‐related deaths and persistent opioid prescribing in primary care in England: a nested case‐control study

British Journal of Clinical Pharmacology ◽

10.1111/bcp.15028 ◽

2021 ◽

Author(s):

Teng‐Chou Chen ◽

Roger David Knaggs ◽

Li‐Chia Chen

Keyword(s):

Primary Care ◽

Case Control Study ◽

Case Control ◽

Opioid Prescribing ◽

Nested Case Control ◽

Control Study

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OP0275 Birth Characteristics and Childhood Infections Predict Ankylosing Spondylitis. A National Register Based Nested Case-Control Study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-eular.1636 ◽

2015 ◽

Vol 74 (Suppl 2) ◽

pp. 176.1-176

Author(s):

U. Lindström ◽

H. Forsblad-d'Elia ◽

J. Askling ◽

L.E. Kristensen ◽

E. Lie ◽

...

Keyword(s):

Ankylosing Spondylitis ◽

Case Control Study ◽

Case Control ◽

National Register ◽

Childhood Infections ◽

Birth Characteristics ◽

Nested Case Control ◽

Control Study

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Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset

British Journal of General Practice ◽

10.3399/bjgp18x700277 ◽

2018 ◽

Vol 69 (680) ◽

pp. e199-e207 ◽

Cited By ~ 1

Author(s):

Joni Jackson ◽

Natalia V Lewis ◽

Gene S Feder ◽

Penny Whiting ◽

Timothy Jones ◽

...

Keyword(s):

Primary Care ◽

Domestic Violence ◽

General Practice ◽

Emergency Contraception ◽

Case Control Study ◽

Case Control ◽

Exposure To Domestic Violence ◽

Nested Case Control ◽

Domestic Violence And Abuse ◽

Control Study

BackgroundEvidence of an association between exposure to domestic violence and abuse (DVA) and use of emergency contraception (EC) is lacking in the UK.AimTo quantify the association between exposure to DVA and consultations for EC in general practice.Design and settingNested case-control study in UK general practice.MethodUsing the Clinical Practice Research Datalink, the authors identified all women all women aged 15–49 years registered with a GP between 1 January 2011 and 31 December 2016. Cases with consultations for EC (n = 43 570) were each matched on age and GP against four controls with no consultations for EC (n = 174 280). The authors calculated odds ratios (ORs) and 95% confidence intervals (CIs) for the association between exposure to DVA in the previous year and consultations for EC. Covariates included age, ethnicity, socioeconomic status, pregnancy, children, alcohol misuse, and depression.ResultsWomen exposed to DVA were 2.06 times more likely to have a consultation for EC than unexposed women (95% CI = 1.64 to 2.61). Women aged 25–39 years with exposure to DVA were 2.8 times more likely to have a consultation for EC, compared with unexposed women (95% CI = 2.08 to 3.75). The authors found some evidence of an independent effect of exposure to DVA on the number of consultations for EC (OR 1.48, 95% CI = 0.99 to 2.21).ConclusionA request for EC in general practice can indicate possible exposure to DVA. Primary care consultation for EC is a relevant context for identifying and responding to DVA as recommended by the World Health Organization and National Institute for Health and Care Excellence guidelines. DVA training for providers of EC should include this new evidence.

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