Actors can help identify rheumatic disorders

Educational intervention leads to earlier diagnoses and faster treatment for ankylosing spondylitis (Pressrelease Maastricht UMC+)

Experiments have revealed that simulated patients can help general practitioners recognise the symptoms of ankylosing spondylitis. Actors with fictitious symptoms were correctly referred on to a rheumatologist more often following an unannounced educational intervention in the GP programme. While ankylosing spondylitis is very difficult to diagnose, learning how to recognise the signs and symptoms will help doctors refer their patients to the right specialist for diagnosis and treatment more quickly. Rheumatologist Marloes van Onna of Maastricht UMC+ carried out her doctoral research on improving the recognition of ankylosing spondylitis.

Ankylosing spondylitis (also known as axial spondylitis) is a chronic inflammation of the spinal column. This rheumatic disorder tends to develop at a young age, between 20 and 45 years old. Due to the diversity of symptoms, this disease is notoriously hard to diagnose. A patient who complains of back pain and other pains is often referred to a neurologist or physical therapist, as back pain is associated with dozens of other diseases as well. As a result, it could take up to ten years to make a diagnosis. In this time, however, ankylosing spondylitis could have devastating results on the patients’ quality of life and may even cause them to lose their jobs. To receive the best possible treatment, it's important that these patients are referred to the right specialists as soon as possible.


To improve diagnoses, actors with fictitious symptoms of ankylosing spondylitis were sent to GPs and GPs in training. These doctors did not know in advance which medical conditions and symptoms they would be confronted with. Three months later, a three-hour lecture on rheumatic disorders, including ankylosing spondylitis, was incorporated into the existing curriculum of the GPs in training. Three months after that, simulated patients scheduled an appointment at the practice. 'The extra training had impressive results,' says PhD candidate Van Onna. 'Before the training, the actors were referred to a rheumatologist approximately 7% of the time. This number increased to 77% after the training.'

Treatment options

At the moment, there is no cure for ankylosing spondylitis. According to Van Onna, however, early diagnosis can significantly improve daily life for patients. 'There are several ways to alleviate symptoms, including anti-inflammatory medications like diclofenac and targeted physical therapy. Biologicals are also being used with considerable success. These are biological medications that block or slow down the inflammatory response. All in all, plenty of reasons to visit the right specialist as soon as possible.'

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