Facebook key to identifying thousands with inflammatory back pain

In the management of IBP, early diagnosis is key to reduce the risk of severe functional disability and early retirement. Correct diagnosis depends largely on the pattern of clinical symptoms and signs in addition to magnetic resonance imaging. Early diagnosis has become all the more important because biological therapies such as TNF inhibitors are available that effectively suppress disease activity and improve functional ability in patients that have been refractory to conventional drug therapy.

A previous UK study showed an average delay in diagnosis of more than eight years, with almost one-third of diagnosed patients not referred to a rheumatologist. This is partly due to a failure of individuals with IBP symptoms to present to their GP, and partly to a failure of GPs to recognise those patients with chronic back pain that have an inflammatory rather than a mechanical cause.

"Patients with inflammatory back pain (IBP) can wait years for a correct diagnosis. Early treatment is critical in achieving better outcomes for these patients. We applied a novel recruitment method using Facebook over five months to identify adults in the community with symptoms suggestive of IBP, comparing the outcome with other forms of recruitment, principally newspaper advertising," said Dr Arumugam Moorthy of the Department of Rheumatology, University Hospitals of Leicester NHS trust, UK. "Facebook advertising recruited a younger group of respondents and a higher proportion of them fulfilled the criteria for a diagnosis of IBP compared to the group of patients recruited by other methods," Dr Moorthy explained.

Back pain is one of the most common medical complaints; it has been estimated to affect as many as 17.3 million people in the UK. However, the majority of these cases are due to a mechanical rather than an inflammatory cause. Among those patients presenting to their doctor at least once with back pain, the minimum estimated prevalence of IBP is equivalent to around 700,000 people. Patients with IBP typically experience severe lower back pain worse at night, not helped by rest, which can significantly interfere with an individual's mental health, ability to work and quality of life.

Of the 585 participants in this study, just over three quarters were recruited through Facebook and under one quarter by other methods. The mean age of the Facebook group was typical of IBP at 41.5 years; the mean age of the non-Facebook group was higher at 59.4 years. Three quarters of the recruited patients were female. Online questionnaire-based surveys to assess the two groups of recruited patients for a diagnosis of IBP showed that, among those recruited by Facebook, 56% met the Calin criteria and ASAS criteria for IBP. In contrast, in the group recruited by non-Facebook methods, 39% met the Calin and ASAS criteria.

The majority of patients from each group reported consulting their GP, however, few patients from either group had been referred to a rheumatologist. Regarding further investigations, 45% of the Facebook group reported having an MRI scan and 45% an X-ray, whereas 50% of the non-Facebook group reported having an MRI scan and 59% said they had been for an X-ray.

"Although most (81%) of the chronic back pain patients we recruited through Facebook had consulted their GP, only 13% had actually been referred to a rheumatologist, confirming the need for additional GP education," Dr Moorthy concluded.