Ab1556-Hpr identifying Barriers in Early Recognition and Management of Patients With Axial Spondyloarthritis: A Retrospective Review

Abstract

BackgroundAxial spondyloarthritis are immune and genetically mediated inflammatory arthritis where there is significant delay in diagnosis and management of roughly 8.5 years; leading to poorer outcome and quality of life for a patient.ObjectivesThis aim of audit was to improve the identification and referral pathways for patients with axial spondyloarthritis in South West Essex United Kingdom as per agreed NICE & EULAR criteria.MethodsThis was a retrospective audit of 35 patients diagnosed as Axial Spondyloarthritis in secondary care and those which was referred to secondary care by community triage MSK service (Connect) as Axial Spondyloarthritis, between January 2019 and March 2020. Data was extracted to look at demographics, diagnostic investigations performed, duration from symptom onset to diagnosis and the patient journey to secondary care.ResultsOut of total 35 patients, 63% were males with a median age of 35 years. Of all the GP referrals 17% were directly to secondary care and 71% were via triage service. Twelve percent of referrals came from other specialties.The average timeframe from symptoms onset to referral by GP was 7.7 years. Average time before a patient was seen by a rheumatologist after referral was 4.4 months.After evaluation in clinic, 30 cases (85.7%) were finally diagnosed as AxSpA after rheumatologist’s review. Rest were mechanical back pain. Inflammatory back pain was mentioned in 18% of referrals by GP and 80% of referrals letters by triage service. Base line investigations included: CRP was in 39% of cases under GP care and 100% cases under triage service. Additionally, HLAB27, X ray and MRI tests were done in 22%, 17% and 22% of GP cases respectively and 86%, 80% and 80% of cases from triage service. After specialist review, HLAB27 was positive in 49% of patients, X ray positive sacroileitis in 54.5% patients and rest had MRI positive sacroileitis and spinal features. Some had both X ray and MRI investigations.ConclusionLack of education and awareness about spondyloarthropathy remains the most prominent factor behind delay to diagnosis. Lack of important information and clinical features on referral letters are also a contributing factor. It is evident that early referral to rheumatologist care and early triaging during reviews are crucial to diagnose AxSpA. We are piloting use of SPADE tool in suspected AxSpA cases to guide clinical reasoning and early referrral.Disclosure of InterestsNone declared