SAT0392 DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS IN DAILY CLINICAL PRACTICE – A SURVEY AMONG DUTCH RHEUMATOLOGISTS
Authors: A. Spoorenberg, S. Arends, M. Sinnige, M. De Hair
Journal: Annals of the Rheumatic Diseases (2020)

Background: Since publication of the ASAS classification criteria for axial spondyloarthritis (axSpA) in 2009 1 and the development of ASAS-endorsed recommendation for early referral of patients with a suspicion of axSpA, 2 awareness for non-radiographic (nr-) axSpA besides Ankylosing Spondylitis (AS) has increased. Still there is limited information of how nr-AxSpA is addressed in daily clinical practice. Objectives: To get insight into the diagnostic phase of axSpA in daily rheumatologic practice in the Netherlands, and to explore if nr-axSpA is addressed differently from AS. Methods: We set up a 21 multiple choice question survey for rheumatologists in the Netherlands with 5 general questions about their practice and 16 questions addressing the diagnostic phase of axSpA. The questionnaire was taken by representatives of the medical department of Novartis NL during structured face-to-face interviews. Rheumatologists in the Netherlands were invited to participate, aiming to get a sample of rheumatologists varying in geographical location and hospital type, as well as a mix of SpA-experts and non-SpA-experts. Rheumatologists gave approval for anonymous use of the data, which were entered in a database and subsequently analyzed using descriptive statistics. Results: From October 15 th 2019 until January 16 th 2020, 36 Dutch rheumatologists participated in the face-to-face survey; 6 from university hospitals, 27 from general hospitals and 3 from private care centers. Most of axSpA patients (61%) were referred by the general practitioner and mean time between referral and first visit was 2-6 weeks. More than 50% of rheumatologists reported a mean symptom duration of &gt;1 year and in 30% even &gt;2 years before first visit. For diagnosing axSpA rheumatologists performed in almost all cases X-pelvis (mean 100% (SD 0%) for both AS and nr-axSpA), CRP/ESR (91% (26%) for AS; 94% (22%) for nr-axSpA) and HLA-B27 (74% (40%) for AS; 86% (26%) for nr-axSpA. MRI of the SI joints was performed in 31% and 82% of patients, respectively, and about 60% of the rheumatologists used of classification criteria for diagnosing axSpA. In addition, rheumatologists marked the level of importance of several (SpA) clinical features for making the diagnosis AS or nr-axSpA (Figure 1). Most rheumatologists graded inflammatory back pain, arthritis/enthesitis/dactylits and uveitis as very important for contributing to the diagnosis. Functional impairment of the spine and male sex were mostly graded neutral or not important for making a diagnosis of axSpA. All features were graded of similar importance for the diagnosis AS and nr-axSpA, except for backpain starting before the age of 45, which was considered more important for diagnosing AS. Conclusion: This survey among Dutch rheumatologists showed that in 30% of patients referred with possible suspicion of axSpA, symptom duration still was &gt;2 years. Almost 60% of rheumatologists make use of the ASAS classification criteria for diagnosing nr-axSpA. Therefore, for early referral awareness of axSpA in first line should enhance. Furthermore, rheumatologists should become aware that classification criteria are not similar to diagnostic criteria and cannot be used as a tick box for diagnosis. References: [1]Rudwaleit M et al, Ann Rheum Dis 2009;68:777-83, 2. Poddubnyy D et al, Ann Rheum Dis 2015;74:1483–7 Acknowledgments: We would like to thank all participating rheumatologists. Disclosure of Interests: Anneke Spoorenberg: None declared, Suzanne Arends Grant/research support from: Grant/research support from Pfizer, Mark Sinnige Employee of: Current employee of Novartis Pharma B.V., Marjolein de Hair Employee of: Current employee of Novartis Pharma B.V.