POS1494-HPR CONSENSUS RECOMMENDATIONS FOR REFERRAL, DIAGNOSIS, MONITORING, AND MANAGEMENT OF AXIAL SPONDYLOARTHRITIS IN THE GULF REGION
Authors: K. Alnaqbi, A. Al Enizi, S. N. S. A. Abdulkarim, E. H. Satti Elsayed, T. Al Lawati, M. Bedaiwi, G. Aldabie
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Axial spondyloarthritis (axSpA) is a chronic inflammatory musculoskeletal disease predominantly affecting the axial skeleton and presenting with diverse extra-musculoskeletal manifestations. Standardized recommendations for the management of axSpA in the context of the Gulf region are limited [1,2]. <h3>Objectives:</h3> This initiative aimed to develop evidence-based consensus overarching principles and recommendations for the referral, diagnosis, monitoring, and management of axSpA patients specifically in the Gulf region. <h3>Methods:</h3> Following EULAR Standardized Operating Procedures, a task force comprising seven expert rheumatologists from Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates formulated PICO questions addressing key aspects pertaining to the referral, diagnosis, monitoring, and management of axSpA. A systematic literature review (PROSPERO CRD42023403697) was conducted using PubMed, Medline, and Cochrane databases to critically appraise the quality of evidence. Six overarching principles and twenty-one recommendations, specifically tailored to the needs of the Gulf healthcare systems, were developed and critically reviewed to assess the quality of evidence and grade of recommendation. Consensus required a level of agreement of 70% or greater through anonymous online voting. Stakeholders comprising clinical rheumatologists, payors, pharmacists, regulators, and patients from across the Gulf region provided external validation through an identical voting process. <h3>Results:</h3> The expert task force and external validators reached a consensus on all overarching principles and recommendations with a level of agreement of 70% or higher. The recommendations align with previously published guidelines, with specific adaptations to patient characteristics and healthcare systems within the Gulf region. The overarching principles (Table 1) emphasize the need for a referral pathway to rheumatologists for suspected axSpA patients. They highlight the use of both pharmacological and non-pharmacological for comprehensive patient care through shared decision-making, with the aim to improve disease symptoms and the quality of life of axSpA patients. The overarching principles also emphasize the need for a multidisciplinary approach to manage and monitor extra-musculoskeletal manifestations (EMM) and comorbidities in axSpA patients. The recommendations (Tables 1 and 2) highlight the need to refer patients with chronic back pain to rheumatologists if they have inflammatory back pain, good response to non-steroidal anti-inflammatory drugs, or EMM. Given the low prevalence of HLA-B27 in some ethnicities, patient history, physical examination, and investigations should be considered to facilitate diagnosis. Specialized training for rheumatologists and radiologists is recommended to enhance the interpretation of axSpA imaging. MRI of the sacroiliac joints has been recommended as the primary imaging modality in suspected axSpA patients due to its superior sensitivity and specificity. The recommendations also underscore the need to consider cost-effective treatment options (such as biosimilars) and routes of drug administration (such as subcutaneous or oral routes). axSpA patients with cardiovascular risk must be regularly monitored and multidisciplinary care, including pregnancy-planning and close monitoring of disease activity, must be considered in women with axSpA. Furthermore, the adoption of electronic patient-reported outcome measures is recommended in routine practice to facilitate prompt and informed clinical decisions. Lastly, regional and national registries are crucial to gather real-world data and improve the management of axSpA in the Gulf region. <h3>Conclusion:</h3> These are the first consensus recommendations specific to the Gulf region that are based on an elaborate systematic literature review, integrating clinical evidence and regional expertise to optimize the referral, diagnosis, monitoring, and management of axSpA. <h3>REFERENCES:</h3> [1] Ali et al. Open Access Rheumatol. 2020;12:147-165. [2] Al Rayes et al. Clin Rheumatol. 2022;41(4):991-1002. <h3>Acknowledgements:</h3> We thank Prof. Filip Van den Bosch (Gent University, Belgium) and Prof. Denis Poddubnyy (Charité - Universitätsmedizin Berlin, Germany) for their contributions. Medical writing support was provided by Eric Mario, Connect Communication, Dubai, UAE. <h3>Disclosure of Interests:</h3> <b>None declared.</b>