AB0806 THE JOURNEY OF AXIAL SPONDYLOARTHRITIS IN SPAIN: FROM THE GENERAL PRACTITIONER TO THE RHEUMATOLOGIST
Authors: E. Flores-Fernández, C. Valera-Ribera, I. Vázquez-Gómez, A. V. Orenes Vera, E. Valls-Pascual, À. Martínez-Ferrer, D. Ybáñez-García, A. Sendra-García, J. J. Alegre-Sancho
Journal: Annals of the Rheumatic Diseases (2021)

Background: The delay in the diagnosis of axial spondyloarthropathies (AxSp), with the morbidity and economic burden that this entails, is well known 1,2 . According to the 2017 Atlas of axial spondyloarthritis in Spain 3 , the mean diagnostic delay was 8,5 years, with an average total cost per patient of 659,8€ including medical consultations and complementary tests until diagnosis. However, nowadays there are still many patients who are incorrectly referred from the general practitioner (GP) despite showing typical features of AxSp. Objectives: To describe the AxSp journey until diagnosis and treatment. To analyze additional costs of either a wrong or a delayed referral of the patients with AxSp to rheumatologists. Methods: Type of study: observational, retrospective, descriptive. We included all the patients who were referred to our Department of Rheumatology from Jan-2019 to Dec-2020 and whose final diagnosis was AxSp. All the data since the first contact to the GP until the final diagnosis and initiation of treatment in Rheumatology were collected, including consultations to our emergency department (EmD) and other specialists. The number of consultations, complementary tests (analytical and imaging), as well as the direct costs of all of them were also collected4. A descriptive and associative analysis of these data was carried out using the SPSS software. We used median and interquartile range (IQR) for descriptive analysis and a significant p value &lt; 0,05. Results: From Jan-2019 to Dec-2020, 15 patients with AxSp and a median age of 43 (Interquartile range (IQR) 34-51) years were diagnosed, 10 women and 5 men. The main reason for referral was inflammatory low back pain (66.7%). The 60% of the patients were referred from the GP, followed by the EmD (20%). Despite typical symptoms, 4 patients (26,7%) were initially referred to Traumatology, and 3 out of them returned to the GP without the right diagnosis. The median delay for referral from the GP to the rheumatologist was 47 (IQR 20-173) days. A wrong referral of the patient was associated with a delayed diagnosis (p 0, 018) and higher direct costs of management (p 0, 018). The average cost (including medical consultation and complementary tests) of the patient referred directly to Rheumatology was 267,71 (IQR 193,7-462,3) €, while the average cost of patients referred to other specialists was 578,83 (IQR 368,32-898,7) €. The extra cost of a wrong referral of a patient with AxSp was 311€ on average per patient in our sample (Table 1). Table 1. Women/men 10/5 Median age (years; IQR) 43; 34-51 Median diagnostic delay (days; IQR) 45; 20-173 Median cost of patient referred initially to Rheumatology (€; IQR) 267,71; 193,7-462,3 Median cost of patient referred initially to another specialist (€; IQR) 578,83; 368,32-898,7 Extra cost of wrong referral per patient(€) 311 Conclusion: AxSp is still a disease with a not negligible diagnostic delay, but it seems to be lower than previously reported. A wrong referral of the patient to other specialists, mainly Traumatology, is associated with this delay and can double the cost of managing these patients. This demonstrates the still unmet need of improving the management and referral of the patients with AxSp from the GP to the rheumatologist, ensuring an early diagnosis and treatment at the lowest cost for the system. Our study has limitations due to its small sample size, but preliminary results indicate that a larger-scale study would be necessary to correctly assess the magnitude of this problem. References: [1]Fernández Carballido C. Diagnosing early spondyloarthritis in Spain: the ESPeranza program. Reumatol Clin . 2010;6(SUPPL. 1):6-10 [2]Muñoz-Fernández S et al. A model for the development and implementation of a national plan for the optimal management of early spondyloarthritis: The Esperanza Program. Ann Rheum Dis . 2011;70(5):827-830 [3]Garrido Cumbrera M et al. Atlas de Espondilartritis Axial En España 2017 . Vol 45.; 2017. [4]Generalitat Valenciana. LEY 20/2017, de 28 de diciembre, de la Generalitat, de tasas. [2017/12159]:96-222. Acknowledgements: We would like to thank Novartis for its support. Disclosure of Interests: None declared