BackgroundA US-based study demonstrated that patients with ankylosing spondylitis (AS) experience a significant delay (on average 14 years) from symptom onset to diagnosis of AS.1 Understanding the diagnosis journey of patients with AS and identifying opportunities to reduce misdiagnosis and incorrect referral are crucial to reducing time to diagnosis, preventing irreversible joint damage, and preserving mobility.ObjectivesTo describe the patient journey to AS diagnosis from the patient perspective and differences observed between females and males.MethodsUS adults aged ≥18 years with a self-reported diagnosis of AS were recruited through CreakyJoints, an online patient support community comprising patients with arthritis and arthritis-related diseases and their caregivers. Respondents completed a web-based survey on socio-demographics, clinical symptoms, disease burden, and diagnosis history, which included symptoms that led to seeking care, time from symptom onset to seeking care and from seeking care to AS diagnosis, types of healthcare providers seen, and misdiagnoses. Survey questions were developed following analysis of qualitative interviews of patients with AS and clinical experts, as well as a targeted literature review. Survey results were compared between females and males using 2-sample t tests for continuous variables and chi squared tests for categorical variables.ResultsAmong 235 respondents, 174 (74%) were female. Mean (SD) age of female and male respondents were 48.6 (10.6) and 53.1 (10.3) years, respectively. Although the majority (58% female and 54% male) sought medical care within the first year of symptom onset, female respondents reported a mean of 17.2 years since first symptom onset and 7.5 years since AS diagnosis; while male respondents reported a mean of 20.0 years since first symptom onset and 11.4 years since AS diagnosis. The most common symptoms that led to seeking medical care were back pain, joint pain, stiffness, and fatigue (figure 1A). During the diagnosis process, patients reported seeking medical care from a general practitioner (87%), rheumatologist (65%), orthopedist (27%), chiropractor (26%), and urgent care/emergency room doctor (21%) with no differences between females and males. The most commonly reported misdiagnoses were back problems (56%), psychosomatic (23%), and sciatica (21%) in males, while psychosomatic (41%), back problems (40%), and anxiety/depression (24%) were most common in females. Significantly higher proportions of females reported misdiagnoses of fibromyalgia (21% vs 7%) and psychosomatic (41% vs 23%) (figure 1B).Abstract FRI0180 – Figure 1Most common first symptom to prompt seeking care (A) and most common misdiagnoses (B) in patients with ASConclusionsThe diagnostic process differs among males and females with AS. Our study findings highlight gender differences in initial symptom presentation, misdiagnoses, and time to diagnosis of AS.Reference[1] Deodhar A. Arthritis Rheumatol2016;68:1669–76.AcknowledgementsThis study was sponsored by Novartis Pharma...

BackgroundIn addition to clinician assessment and laboratory tests, patient-reported outcomes (PROs) are important for managing and improving the quality of care in patients with psoriatic arthritis (PsA). The RAPID3 was originally developed for use in patients with rheumatoid arthritis, but it may be used in clinical practice to assess disease activity in patients with PsA.1 The PROMIS10 is a general (nondisease-specific) PRO instrument that measures physical, mental, and social health.2 Developed for the general population, PROMIS10 has not yet been specifically validated in PsA.ObjectivesTo evaluate the relationship between RAPID3 and PROMIS10 in patients with PsA.MethodsUS adults with a self-reported diagnosis of PsA were recruited through CreakyJoints (www.CreakyJoints.org), an online patient support community comprising patients with arthritis and arthritis-related diseases and their caregivers. Respondents completed an online survey that was designed to collect data on socio-demographics and clinical symptoms and included the RAPID3 and PROMIS10 to evaluate disease activity and health-related quality of life (HRQoL), respectively. The RAPID3 consists of three patient self-reported scores (0–10): functional impairment, pain, and patient global assessment; total scores≤3.0=near remission, 3.1 to 6.0=low disease severity, 6.1 to 12.0=moderate disease severity, and ≥12.1 = high disease severity. PROMIS10 is a 10-item survey measuring physical and mental domains; individual scores are transformed to T-score distributions normalised to the general population. PROMIS10 individual scores and global physical and mental health T-scores were stratified by RAPID3 disease severity and compared across RAPID3 severity levels using Kruskal-Wallis or ANOVA tests, respectively. Spearman’s correlation coefficient was calculated between RAPID3 total score and the PROMIS10 physical health and mental health T-scores, respectively.ResultsAmong 203 respondents, the mean (SD) age was 51.6 (10.8) years and 172 (84.7%) were female. The mean (SD) cumulative RAPID3 score was 14.7 (5.8) with mean (SD) functional impairment, pain tolerance, and patient’s global estimate scores of 3.3 (1.8), 6.0 (2.3), and 5.4 (2.5), respectively. Patients’ mean (SD) PROMIS10 global physical and mental health T-scores were 36.4 (7.3) and 40.2 (9.3), respectively. The mean individual domain scores and global T-scores worsened with increasing RAPID3 disease severity levels (all p<0.001) (table 1). PROMIS10 physical and mental health T-scores showed a strong (r s=−0.84) and moderate correlation (rs=−0.57) with RAPID3, respectively.Abstract AB0904 – Table 1PROMIS10 Scores and Impact of PsA on Work by RAPID3 Disease Activity in Patients with PsAPROMIS10, Patient-Reported Outcome Management Information System Global Health short form; RAPID3, Routine Assessment of Patient Index Data 3.* Disease severity classified by RAPID3 scores:≤3.0=near remission; 3.1 to 6.0=low severity; 6.1 to 12.0=moderate severity;≥12.1= high severity.ConclusionsRAPID3 and PROMIS10 phys...

BackgroundPatient-reported outcome (PRO) measures are important in managing and improving the quality of care in patients with chronic rheumatic conditions including ankylosing spondylitis (AS). The RAPID3 was developed for use in patients with rheumatoid arthritis, but it has shown good correlation with the BASDAI and ASDAS in patients with AS.1 The PROMIS10 is a universal (non-disease specific) PRO measure that quantifies physical and mental health;2 validity of PROMIS10 has not been examined in patients with AS.ObjectivesTo evaluate the relationship between RAPID3 and PROMIS10 in patients with AS.MethodsUS patients aged ≥18 years with a self-reported diagnosis of AS were recruited through CreakyJoints (www.CreakyJoints.org), an online patient support community comprising patients with arthritis and arthritis-related diseases and their caregivers and via outreach on social media. Respondents completed a web-based survey designed to collect data on socio-demographics and clinical symptoms, RAPID3, and PROMIS10. The RAPID3 score consists of three patient self-reported scores (0–10): functional impairment, pain, and patient global assessment; total scores≤3.0=near remission, 3.1 to 6.0=low disease severity, 6.1 to 12.0=moderate disease severity, and ≥12.1 = high disease severity. PROMIS10 is a 10-item questionnaire measuring physical, mental, and social domains; physical and mental health domain scores are transformed to T-score distributions normalised to the general population (mean score=50). PROMIS10 individual scores and global physical and mental health T-scores were stratified by RAPID3 disease severity and compared across RAPID3 severity levels using Kruskal-Wallis or ANOVA or tests, respectively. Spearman’s correlation coefficient was calculated between the RAPID3 total score and the PROMIS10 physical health and mental health T-scores, respectively.ResultsAmong 235 respondents, 174 (74%) were female, with a mean (SD) age of 49.8 (10.7) years. The mean (SD) RAPID3 cumulative score was 15.4 (5.4) The mean (SD) PROMIS10 global physical and mental health T-scores were 35.60 (7.39) and 39.89 (8.76), respectively, with individual domain scores and global T-scores decreasing with worsening RAPID3 disease activity (table 1; p<0.0001 for all). PROMIS10 physical and mental health T-scores showed a showed a strong correlation with RAPID3 (r s=−0.84 and −0.63, respectively).Abstract AB0849 – Table 1PROMIS10 Scores by RAPID3 Disease Activity in Patients with ASAS, ankylosing spondylitis; PROMIS10, Patient-Reported Outcome Management Information System Global Health short form; RAPID3, Routine Assessment of Patient Index Data 3.* Disease severity classified by RAPID3 scores:≤3.0=near remission; 3.1 to 6=low severity; 6.1 to 12.0=moderate severity;≥12.1= high severity.ConclusionsRAPID3 and PROMIS10 are relatively short questionnaires that can be used in the real world to track and monitor disease symptoms and health-related quality of life in patients with AS. RAPID3 and PROMIS10 were strongly correlated in patients with...

Autoimmune Polyendocrine Syndromes (APS) are rare autoimmune endocrinopathies, characterized by the association of two or more organ-specific disorders. Type II Autoimmune Polyendocrine Syndromes (APS II) comprises the association of Addison’s disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. Although the classic presentation is symptomatic hypotension, it can manifest as an adrenal crisis - a life-threatening condition. We report a case of a 41-year-old woman with prolonged asthenia, cutaneous hyperpigmentation and symptomatic hypotension refractory to intravenous fluids. APS II was diagnosed with a presentation of an Addisonian crisis, resolved after the onset of hydrocortisone.

BackgroundPsoriatic arthritis (PsA) is a heterogeneous, chronic, immune-mediated disease characterised by a range of musculoskeletal conditions including joint pain, swelling, enthesitis and dactylitis as well as skin and nail manifestations. Early diagnosis of PsA is important as shorter time to treatment may improves outcomes.1 However, PsA is often undiagnosed or misdiagnosed.2 There is limited information on the diagnostic experiences of patients with PsA, including medical care sought and potential barriers to diagnosis.ObjectivesTo determine patients’ experiences related to the diagnosis of PsA including initial symptoms experienced, medical care sought, and time to diagnosis.MethodsUS patients aged ≥18 years with a self-reported diagnosis of PsA were recruited through CreakyJoints (www.Creakyjoints.org), an online patient support community comprising patients with arthritis and arthritis-related diseases and their caregivers, and outreach through social media. Participants completed an online survey designed to collect data on socio-demographics, clinical symptoms, disease burden, and diagnosis history, including initial PsA symptoms experienced, types of health care providers seen, misdiagnoses received before a diagnosis of PsA, and time to PsA diagnosis. Survey questions were developed following analysis of qualitative interviews of patients with PsA and clinical experts, as well as a targeted literature review.ResultsOf the 203 patients included in the study, 172 (85%) were female, with a mean (SD) age of 51.6 (10.8) years; 132 patients (65%) had private insurance, 61 (30%) Medicare, and 25 (12%) Medicaid. The most common initial symptoms that led patients to seek medical attention were joint pain (142 patients [70%]), stiffness (109 [54%]), swollen joints (101 [50%]), skin rash/psoriasis (97 [48%]), and fatigue (96 [47%]). Most patients (153 [75%]) sought medical treatment within 2 years of symptom onset. During the diagnosis process, patients most commonly sought care from a general practitioner (162 [80%]), rheumatologist (135 [66%]), dermatologist (67 [33%]), orthopedist (44 [22%]), and/or podiatrist (25 [12%]). Only 8 patients (4%) reported that they had never received a misdiagnosis; common misdiagnoses were psychosomatic disease, osteoarthritis, and anxiety/depression (figure 1). Patients reported median (IQR) time since diagnosis of 6.0 (2–11.5) years. Many patients (94 [51%]) received a diagnosis of PsA ≤1 year after seeking medical attention; however, 25 (17%) and 31 (15%) patients received a PsA diagnosis ≥5 and>10 years after seeking medical attention for the first time, respectively.Abstract THU0292 – Figure 1Misdiagnoses Received Before Diagnosis of PsA (N=203). PsA, psoriatic arthritisConclusionsThis study showed that patients often had substantial delays and misdiagnoses before they received a PsA diagnosis. Increased understanding of the diagnostic barriers may lead to earlier diagnosis and appropriate treatment that may improve outcomes.References[1] Haroon M, et al. Ann Rheum Dis2015;...