Background/Purpose: Whilst the burden of axial spondyloarthritis (axSpA) is well known, non-radiographic (nr)-axSpa has only recently been identified as a distinct spondyloarthritic indication with its own associated burden. As such, evidence demonstrating the clinical and healthcare system burden of illness is sparse.

Methods: Data were taken from the 2014 nr-axSpA Disease Specific Programme (DSP) a cross-sectional, multi-national survey of nr-axSpA patients and their rheumatologists in France, Germany, Italy, Spain and the UK. Rheumatologists completed patient record forms containing patient demographics, clinical results, symptomology, information on acute episodes and consultations and hospitalisations in the last 12 months. Patients were defined to be non-responsive to current treatment if they were currently experiencing an acute episode, or had worsened in severity or remained severe since initiation of current therapy, or the physician was dissatisfied with their current level of control. Responders were defined as the inverse of non-responders. To adjust for the design bias of the DSP, the number of consultations in the last 12 months was used as an inverse probability weight. The weight was applied to all percentages, means and standard deviations.

Results: A total of 631 patients were included in the analysis (mean age 41.8±12.0 [SD], 70.4% male). Mean age at onset was 35.0±11.2, while 27.3% were classified as having moderate or severe disease state. Over half (56.7%) of patients were currently suffering from inflammatory back pain (IBP) ranging from 43.4% in Spain to 68.4% in Germany, and 18.1% were asymptomatic. On average patients were receiving 1.7 pharmacological products, with little variation across countries. Mean number of consultations with a primary care provider in the last 12 months varied from 1.0 in the UK to 3.2 in Italy. The UK also had the lowest mean number of consultations with a specialist while Germany had the highest (1.8 vs. 3.6). Minimal time was spent in hospital as a result of nr-axSpA with only 0.1 nights spent in hospital on average. Under a quarter (22.9%) of patients were defined to be non-responders. Only 22.5% of non-responders were currently receiving biologic therapy compared to 43.2% of responders.

Conclusion: Nr-axSpa patients suffer from various chronic and acute symptoms and associated pain, while a considerable proportion of patients were non-responsive to their nr-axSpA treatment. Inter-country patient management differences were observed, and may be associated with corresponding unmet clinical needs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/burden-of-illness-associated-with-non-radiographic-axial-spondyloarthritis-a-european-real-world-database-analysis-from-the-clinical-and-healthcare-system-perspective/