FRI0180 Diagnosis journey of patients with ankylosing spondylitis in the united states

Background A US-based study demonstrated that patients with ankylosing spondylitis (AS) experience a significant delay (on average 14 years) from symptom onset to diagnosis of AS.1 Understanding the diagnosis journey of patients with AS and identifying opportunities to reduce misdiagnosis and incorrect referral are crucial to reducing time to diagnosis, preventing irreversible joint damage, and preserving mobility. Objectives To describe the patient journey to AS diagnosis from the patient perspective and differences observed between females and males. Methods US adults aged ≥18 years with a self-reported diagnosis of AS were recruited through CreakyJoints, an online patient support community comprising patients with arthritis and arthritis-related diseases and their caregivers. Respondents completed a web-based survey on socio-demographics, clinical symptoms, disease burden, and diagnosis history, which included symptoms that led to seeking care, time from symptom onset to seeking care and from seeking care to AS diagnosis, types of healthcare providers seen, and misdiagnoses. Survey questions were developed following analysis of qualitative interviews of patients with AS and clinical experts, as well as a targeted literature review. Survey results were compared between females and males using 2-sample t tests for continuous variables and chi squared tests for categorical variables. Results Among 235 respondents, 174 (74%) were female. Mean (SD) age of female and male respondents were 48.6 (10.6) and 53.1 (10.3) years, respectively. Although the majority (58% female and 54% male) sought medical care within the first year of symptom onset, female respondents reported a mean of 17.2 years since first symptom onset and 7.5 years since AS diagnosis; while male respondents reported a mean of 20.0 years since first symptom onset and 11.4 years since AS diagnosis. The most common symptoms that led to seeking medical care were back pain, joint pain, stiffness, and fatigue (figure 1A). During the diagnosis process, patients reported seeking medical care from a general practitioner (87%), rheumatologist (65%), orthopedist (27%), chiropractor (26%), and urgent care/emergency room doctor (21%) with no differences between females and males. The most commonly reported misdiagnoses were back problems (56%), psychosomatic (23%), and sciatica (21%) in males, while psychosomatic (41%), back problems (40%), and anxiety/depression (24%) were most common in females. Significantly higher proportions of females reported misdiagnoses of fibromyalgia (21% vs 7%) and psychosomatic (41% vs 23%) (figure 1B). Abstract FRI0180 – Figure 1 Most common first symptom to prompt seeking care (A) and most common misdiagnoses (B) in patients with AS Conclusions The diagnostic process differs among males and females with AS. Our study findings highlight gender differences in initial symptom presentation, misdiagnoses, and time to diagnosis of AS. Reference [1] Deodhar A. Arthritis Rheumatol2016;68:1669–76. Acknowledgements This study was sponsored by Novartis Pharmaceuticals Corporation, East Hanover, NJ. Disclosure of Interest A. Ogdie Grant/research support from: Pfizer and Novartis, Consultant for: Abbvie, BMS, Eli Lilly and Company, Novartis, Takeda, and Pfizer, W. B. Nowell Employee of: Global Healthy Living Foundation, R. Reynolds: None declared, K. Gavigan Employee of: Global Healthy Living Foundation, S. Venkatachalam Employee of: Global Healthy Living Foundation, M. de la Cruz Employee of: ICON, E. Flood Employee of: ICON, E. Schwartz Employee of: ICON, B. Romero Employee of: ICON, Y. Park Employee of: Novartis Pharmaceuticals Corporation