POS0994 NON-RHEUMATOLOGISTS FIND IT DIFFICULT TO IDENTIFY AXIAL SPONDYLOARTHRITIS IN WOMEN AND YOUNG PEOPLE. RESULTS FROM THE SPANISH ATLAS
Authors: M. Garrido-Cumbrera, V. Navarro-Compán, J. Gratacos-Masmitja, P. Zarco-Montejo, J. Correa-Fernández, C. Sastré, P. Plazuelo-Ramos, E. Collantes-Estevez
Journal: Annals of the Rheumatic Diseases (2021)

Background: Delayed diagnosis in axial spondyloarthritis (axSpA) in Spain seems to be influenced by the patient diagnostic pathway. In particular, not all patients are diagnosed by rheumatologists, the profession better suited to make an axSpA diagnosis. Objectives: The aim of this study is to evaluate the differences between patients diagnosed by a rheumatologist and those diagnosed by other healthcare professionals (HCPs). Methods: In 2016, a sample of 680 unselected patients with axSpA participated in the Atlas of Axial Spondyloarthritis in Spain, an online survey. The sample was divided into: 1) Patients diagnosed by rheumatologists and 2) Non-Rheumatologist diagnosis including general practitioner, orthopaedic specialist, and physiotherapist. The Mann-Whitney and Pearson’s chi-square tests were used to assess possible differences between both groups in sociodemographic characteristics, employment, lifestyle, patient-reported outcomes, and comorbidities. Univariate and multivariate binary logistic regression was used to analyse the possible factors associated with diagnosis by a non-Rheumatologist. Results: A total of 522 axSpA patients participated in this study: the mean age was 45.3 years, 51.0% were female, 38.5% had a university degree, and 71.6% and were married. Prior to diagnosis, axSpA patients visited different HCPs such as a General Practitioner (GP) (88.5%), orthopaedic specialists (71.6%), rheumatologists (71.0%), and physiotherapists (46.9%). The greatest number of visits (mean, median) were made to physiotherapists (3.4, 3), followed by orthopaedic specialists (3.0, 2), rheumatologists (2.0, 1) and GPs (2.6, 2). The majority (81.4%) of patients were diagnosed by a rheumatologist, while 18.6% received their diagnosis from a non-rheumatologist (10.9% orthopaedic specialist, 7.3% general practitioner, and 0.4% physiotherapist). With respect to other specialists such as the GP, orthopaedic specialist or physiotherapist, patients diagnosed by the rheumatologist were younger (44.3 vs 49.5, p&lt;0.001), more frequently female (54.8% vs 45.2% of male, p&lt;0.001), with worse mental health (5.9 vs 4.8, p=0.039), who visited more professionals before being diagnosed (3.0 vs 2.5, p=0.001), were more frequently smokers (40.2% vs 26.0%, p=0.010) and used more biologicals (45.9% vs 33.0%, p=0.021). In the multivariate binary logistic regression, the qualitative factors associated with diagnosis by non-rheumatologists are males (OR= 1.80), and the quantitative factors associated with the diagnosis by non-rheumatologists are older age (B=0.027; Table 1). Table 1. Logistic regression to analyses factor associated with non-rheumatologist diagnosis (N= 440) Univariate logistic analysis* Multivariate logistic analysis* OR p-value 2 OR p-value 2 Qualitative factors Gender. Female 1 2.354 &lt;0.001 1.797 0.030 Smoking. Yes 0.523 0.010 0.611 0.095 Used of Biologics. Yes 0.581 0.022 0.640 0.086 Quantitative factors B p-value 3 B p-value 3 Age, in years 0.044 &lt;0.001 0.027 0.028 GHQ-12 (0-12) -0.059 0.038 -0.011 0.721 Number of HCPs seen before diagnosis -0.294 0.001 -0.153 0.151 *Reference category of the dependent variable: Non-Rheumatologist; 1 Female vs male; 2 p-value for test H 0 : OR = 1 3 p-value for test H 0 : B = 0 Conclusion: One out of five patients with axSpA in Spain were not diagnosed by rheumatologists. Patients diagnosed by non-rheumatologists were more likely male and older, suggesting that the suspicion of axSpA in females and younger patients is low among these healthcare professionals. Beside the rheumatologist, it is essential to educate other HCPs on axSpA diagnostic criteria in order to facilitate correct referrals to rheumatologists and shorten the time to diagnosis and effective treatment. Acknowledgements: This study was supported by Novartis Spain. The authors would like to thank all patients who participated in the study Disclosure of Interests: Marco Garrido-Cumbrera: None declared, Victoria Navarro-Compán Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Jordi Gratacos-Masmitja Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Pedro Zarco-Montejo: None declared, José Correa-Fernández: None declared, Carlos Sastré Employee of: Novartis Farmacéutica Spain, Pedro Plazuelo-Ramos: None declared, Eduardo Collantes-Estevez Grant/research support from: Abbvie, BMS, Lilly, MSD, Novartis, Pfizer, Roche, and UCB.