EP39 Assessing the differences in times to general practitioner presentation and diagnosis, and outcomes, for axial spondyloarthritis patients in different ethnic groups
Authors: Owusu-Agyei Amanda , Verdiyeva Ayna , Chan Marian 
Published: April 2020

Abstract

Background
There is a documented delay to diagnosis of axial spondyloarthritis. The Luton & Dunstable University Hospital Rheumatology department looks after an ethnically diverse population of patients with the condition. This study aimed to compare time from symptom onset to general practitioner (GP) presentation, time from symptom onset to diagnosis, and response to treatment between different ethnic groups.

Methods
124 patients with axial spondyloarthritis, according to the Luton & Dunstable University Hospital Infoflex database, were identified. 24 patients were excluded due to a peripheral spondyloarthritis diagnosis. A retrospective case note review of 100 case records was undertaken. Data were analysed using Microsoft Excel.

Results
The mean age was 44 years. 64 (64%) patients were male and 36 (36%) were female. Ethnicity breakdown showed 58 White British patients; 12 Pakistani; 7 White Other; 6 Bangladeshi; 5 White Irish; 5 Asian; 4 Indian and 3 Black Caribbean. There were 70 Caucasian (White British, Irish or Other) and 30 non-Caucasian patients. Based on available data for 57 patients, the median time of symptom onset to GP presentation was 48 months. Based on available data for 49 patients, the median time of symptom onset to diagnosis was 53 months. The mean time of symptom onset to GP presentation was 93 months in Caucasians vs. 66 months in non-Caucasians. The mean time of symptom onset to diagnosis was 91 months in Caucasians vs. 70 months in non-Caucasians. 12 patients presented within one year of symptom onset. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) data were available for 7/12 patients who presented within one year of symptom onset and 25/45 patients who presented after one year. Following NSAIDs or biologics, there was a larger decrease in the first measured BASDAI for those who presented within one year of symptom onset (Mean BASDAI decrease: 2.77 vs. 2.06). BASDAI data were available for 43/70 Caucasian patients and 18/30 non-Caucasian patients, regardless of time of presentation. The mean decrease in first measured BASDAI was smaller in Caucasian patients vs. non-Caucasian patients (Mean BASDAI decrease: 2.49 vs. 2.66). BASDAI data were available for 5/7 Caucasian and 2/5 non-Caucasian patients presenting within one year of symptom onset. The mean BASDAI decrease was 5.65 in non-Caucasian patients vs. 1.62 in Caucasian patients. BASDAI data were available for 15/26 Caucasian and 10/19 non-Caucasian patients presenting after one year of symptom onset. Mean BASDAI decrease was 2.26 in non-Caucasian vs. 1.93 in Caucasian patients.

Conclusion
There is a shorter mean time of symptom onset to GP presentation and diagnosis in non-Caucasians compared to Caucasians. There is a higher response to treatment in patients who present within one year of symptom onset, supporting the hypothesis that early diagnosis leads to better outcomes.
Disclosures: A. Owusu-Agyei: None. A. Verdiyeva: None. M. Chan: None.