SAT0255 Real World Comparison of Ankylosing Spondylitis and Non-Radiographic Axial Spondyloarthritis Patients – Investigating Patient Profiles and Treatment Strategies
Authors: L. Chanroux, J. Casellas
Journal: Annals of the Rheumatic Diseases (2015)

<h3>Background</h3> Axial spondyloarthritis (axSpA) is still a relatively new term in rheumatology and the recent nomenclature separating axial vs. peripheral and radiographic and non-radiographic spondyloarthritis has changed the perspective of ankylosing spondylitis (AS) by switching the focus towards earlier diagnosis and treatment of the disease. <h3>Objectives</h3> The aim of our study was to better understand the differences between patients with non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis and assess whether treatment strategies that have demonstrated efficacy in AS can be applied to earlier forms of the disease. <h3>Methods</h3> We used patient record data collected as part of an online treatment survey conducted among a panel of 257 European rheumatologists in 2014 across the main 5 EU markets of France, Germany, Italy, Spain, UK. We review 2038 patient cases for nr-axSpA and 5569 for AS. All data were tested for statistical significance using two-sided tests with a significance level of 0.05 <h3>Results</h3> On average, nr-axSpA patients were significantly younger (38.5 year) than AS patients (40.0) and were significantly more likely to be female (41.2% vs. 27.1%). We observed a similarly high proportion of comorbidities among patients from both groups and AS patients were significantly more likely to suffer from enthesitis, hypertension, uveitis and Crohn9s disease. Nr-axSpA patients more commonly suffered from fibromyalgia and depression. There were no significant differences in physicians9 perceptions of patients9 current disease severity although nr-axSpA patients were more commonly thought to have mild disease at diagnosis (21.4% vs. 14.6% for AS) while AS patients were more likely to be severe (26.9% vs. 19.8% for nr-axSpA). While nr-axSpA patients were reported to have significantly higher mean BASDAI scores (2.6 vs. 2.1) a greater proportion of AS patients were unable to work due to their disease (3.1% vs. 2.0%). This may in part be due to the fact that a greater proportion of AS patients had axial and peripheral joint involvement (38.9% vs. 31.7% for nr-axSpA). We also observed key differences in the treatment approaches used in both groups. While the mean time between diagnosis and first biologic was significantly shorter for nr-axSpA patients (24.1 months vs. 44.9 for AS) and they tried, on average, fewer non-steroidal anti-inflammatories (NSAIDS) before biologic therapy, overall use of biologics was higher among AS patients (52.3% vs. 43.8% for nr-axSpA). Conversely nr-axSpA patients were significantly more likely to be treated with corticosteroids and NSAIDS. <h3>Conclusions</h3> Overall, our data suggests that nr-axial SpA is a more heterogenous disease when compared to AS however, physicians appear to be comfortable with using therapies that have demonstrated efficacy in AS and using aggresive step-up approaches to treatment combining biologics, steroids and NSAIDS early in the disease to maximise patient outcomes. <h3>Disclosure of Interest</h3> None declared