POS0509 TIME TO DIAGNOSIS AND ASSOCIATED COMORBIDITY BURDEN IN AXIAL SPONDYLOARTHRITIS IN GENERAL PRACTICE IN FRANCE: RESULTS FROM THE THIN® DATABASE
Authors: C. Prati, A. Constantin, E. Dernis, S. Le Mouel, M. Rozenblat, J. E. Gottenberg, C. Tamberou, E. Arnee, A. Vyncke, M. Ducros, J. Gandrup Horan
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Delayed diagnosis of axial spondyloarthritis (axSpA) remains a challenge for multiple reasons, including lack of awareness in primary care and difficulty in distinguishing chronic inflammatory back pain from other, more prevalent back pain types. Longer diagnostic delays are associated with worse clinical, psychological, social and economic outcomes [1]. Investigating the time to diagnosis and associated comorbidity burden will help inform targets for improvement and raise awareness. <h3>Objectives:</h3> To describe the patient characteristics and comorbidity burden at the time of earliest recorded back pain in general practice and at the time of axSpA diagnosis, and to estimate the time to diagnosis of axSpA from earliest recorded back pain in general practice. <h3>Methods:</h3> This retrospective descriptive study utilized data from the French electronic health records THIN® database from a representative sample of 2,000 general practitioners (GPs) between January 2010 and August 2023. Adult patients with axSpA and at least 3 years of continuous enrollment with their GP prior to axSpA diagnosis with documented back pain in their medical history prior to axSpA diagnosis were included. Patients diagnosed with rheumatoid arthritis and psoriatic arthritis within one year preceding axSpA diagnosis were excluded. Musculoskeletal, non-musculoskeletal manifestations and comorbidities were assessed at 1) the time of earliest recorded back pain by the GP and 2) the time of axSpA diagnosis. Time to diagnosis was defined as time between these two time points. Results were reported descriptively using summary statistics. <h3>Results:</h3> A total of 4,402 patients with axSpA were included, with a mean (standard deviation, SD) number of years with available data before axSpA diagnosis of 10.4 (4.9) years. In this cohort, 43% were male and the mean (SD) age was 40 (14) at earliest back pain diagnosis and 47 (14) years at axSpA diagnosis. The burden of musculoskeletal, non-musculoskeletal manifestations and comorbidities increased between the time of earliest recorded back pain and the time of axSpA diagnosis, with the number of patients with multiple comorbidities increasing from 32% to 60%. The largest increases were seen for enthesitis, fatigue, depression and anxiety (Figure 1). The mean (SD) time in years between the earliest back pain diagnosis recorded by the GP and the first axSpA diagnosis was 6.3 (4.5) years, with 38% of patients experiencing a time to diagnosis longer than 7 years. No differences in time to diagnosis between males and females were observed. Patients had a median (Q1, Q3) of 3 (2, 7) documented back pain episodes recorded in their GP records prior to their axSpA diagnosis, with 26,857 total back pain consultations recorded for the entire cohort over the study period. The distribution of specific locations and types of back pain diagnoses are shown in Figure 2. <h3>Conclusion:</h3> Diagnostic delay remains a key challenge for patients with axSpA in France, with several consultations for back pain in primary care prior to diagnosis and an average time to diagnosis of over 6 years after the earliest back pain consultation. An increased number of musculoskeletal, non-musculoskeletal manifestations and comorbidities were observed at the time of axSpA diagnosis compared to when back pain was first consulted for, highlighting worsening disease burden over time. Importantly, patients may have experienced pain long before consulting their GP, further contributing to diagnostic delays. Interventions are needed to support GPs in recognising chronic back pain patients who could benefit from a timely referral to rheumatology. Earlier diagnosis of axSpA may ultimately lower the burden on patients, healthcare systems and society. <h3>REFERENCES:</h3> [1] Yi E et al. Rheumatol Ther. 2020 Mar;7(1):65-87. <h3>Acknowledgements:</h3> Funded by UCB Pharma. <h3>Disclosure of Interests:</h3> Clément Prati Speakers bureau for AbbVie, Janssen, Novartis, Sandoz and UCB Pharma, Consultant for Celltrion, Janssen, Lilly, Novartis and Sandoz, Grant/research support from Fresenius and Pfizer, Arnaud Constantin Speakers bureau for AbbVie, Amgen, Biogen, BMS, Boehringer Ingelheim, Celltrion, Fresenius Kabi, Galapagos, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche, Sanofi, Sandoz, UCB Pharma and Viatris, Consultant for AbbVie, Amgen, Boehringer Ingelheim, Celltrion, Fresenius Kabi, Galapagos, Janssen, Lilly, Novartis, Pfizer, Sanofi and UCB Pharma, Grant/research support from AbbVie, Biogen, BMS, Galapagos, Lilly, Hoffman-La Roche, MSD, Janssen, Novartis, Pfizer, Sanofi and UCB Pharma, Emmanuelle Dernis Speakers bureau for Abbvie, BMS, Janssen, Lilly, Medac, MSD, Novartis, Pfizer, Roche and UCB Pharma, Consultant for Janssen, Lilly, Novartis, Pfizer and UCB Pharma, Grant/research support from Lilly and Novartis, Stéphane Le Mouel Paid instructor for Amgen and Sanofi, Consultant for Boiron, Kappa Santé and LEO Pharma, Marc Rozenblat: None declared, Jacques-Eric Gottenberg Speakers bureau for Abbvie, BMS, Galapagos, Gilead, Lilly, MSD, Novartis, Pfizer, Sanofi and UCB Pharma, Cheikh Tamberou As a consultant in a research firm, we are called upon to collaborate with the entire pharmaceutical industry, Elise Arnee Previous employee of Biocodex and Novartis, As a consultant in a research firm, we are called upon to collaborate with the entire pharmaceutical industry, Anneleen Vyncke Employee of UCB Pharma, Marie Ducros As a consultant in a research firm, we are called upon to collaborate with the entire pharmaceutical industry, Julie Gandrup Horan Shareholder of UCB Pharma, Employee of UCB Pharma.