AB0686 ONLINE QUESTIONNAIRE CAN IMPROVE DELAY IN AXIAL SPONDYLOARTHRITIS DIAGNOSTICS. RESULTS OF SAINT PETERSBURG AXSPA EARLY DIAGNOSTICS PROJECT
Authors: E. Gaydukova, V. Mazurov, O. Inamova, E. Vasilenko, I. Gaydukova
Journal: Annals of the Rheumatic Diseases (2020)

Background: Due to current data mean diagnostics delay in axial spondyloarthritis (axSpA) is 7.4 ± 8.4 years (mean ± SD) [1]. However, development of specific and high sensitive criteria of axSpA do not improve the situation because one of the main reasons of late axSpA diagnostics is the increased period when the patient with typical axSpA symptoms do not referred by general practitioner (GP) to the rheumatologists (so called «human factor»). The increasing role of internet online technologies can make way from GP to rheumatologist shorter and decrease the diagnostics delay in axSpA. Objectives: To develop the online questionnaire that calculates probability of having axSpA and evaluate the advantages of the method of online based detection of axSpA under the traditional ways of axSpA search. Methods: Based on positive and negative predictive values of symptoms from ASAS axSpA criteria (2009) the axSpA Early Diagnostics Questionnaire (aEDQ) was developed. The aEDQ was available on website of Russian Ankylosing Spondylitis Association from October 2018. Link to the aEDQ could be obtained directly on the site and additionally by using one of 1,500 related to axSpA keywords approved by 5 rheumatologists from Russian SpA Expert Group. Those of participants who had high risk of axSpA according aEDQ were recommended to visit the rheumatologist, related to axSpA diagnostics. Participants with low risk of axSpA were sent to their GP. Collected data of diagnostics delay and capacity of the aEDQ were compared with data from demographically matched populations from EMAS online survey from 13 European countries (n=2,846), and SPACE cohort results (n=461) [1, 2], and from Russian North-Western axSpA LADOGA register (n=1,544). This study used only anonymized data. Statistical analysis was performed with Statistica SPSS2017, GraphPadPrizme 2016. Results: Since October 2018 until January 2019 in Saint-Petersburg 22,925 people visited the aEDQ, 21,939 (95.6%) people filled out the questionnaire. Out of 21,939 people filled out questionnaire 7,888 (35.95%) people has high risk of axSpA. Within one month after passed the questionnaire 424 people with high risk of axSpA (5% out of all who had the recommendation) consulted by rheumatologist (mean age 42±6.6 years, male 275 (65%), symptoms duration 4.4 ± 3.0 years, HLA-B27 positive 292 (68.3%)). In 254 patients out of 424 (59.9%) presence of axSpA was confirmed as compared with 44.6% in SPACE cohort results (χ2 = 19.24, p&lt;0.000 for differences with SPACE cohort results [2]). Mean diagnostics delay in aEDQ cohort was 4.4 ± 3.0 years (mean ± SD), n = 254, in axSpA patients with traditional way of axSpA search in LADOGA register was 8.8 ± 4.8 years, n=1,544 (LADOGA study results), and 7.4 ± 8.4 years in EMAS survey [1], p &lt; 0.0001 for all the differences. Conclusion: Online axSpA Early Diagnostics Questionnaire with function of calculation of axSpA probability can decrease diagnostics delay and increase percentage of confirmed by rheumatologist axSpA diagnosis as compared with another forms of axSpA search. References: [1]Garrido-Cumbrera M, EMAS Working Group. Curr Rheumatol Rep. 2019; 21(5): 19. doi: 10.1007/s11926-019-0819-8 [2]Poddubnyy D, et al. RMD Open. 2018 Dec 5;4(2):e000825. doi: 10.1136/rmdopen-2018-000825. eCollection 2018. Acknowledgments: Alexey Sitalo Disclosure of Interests: Ekaterina Gaydukova: None declared, V Mazurov: None declared, Oxana Inamova: None declared, Elizaveta Vasilenko: None declared, Inna Gaydukova Grant/research support from: JSC BIOCAD, Speakers bureau: Pfizer, Novartis, AbbVie, JSC BIOCAD, Сelgene, MSD, Sanofi