Background/Purpose

The current recommendations for optimal monitoring of axial spondyloarthritis (SpA) are to assess regularly disease activity. The two proposed tools comprise clinical aspects as well as laboratory abnormalities, e.g. BASDAI and C-Reactive Protein, or ASDAS [1].

To evaluate the tools used by rheumatologists in axial SpA patients in their daily practice and the potential interest of a meeting during which rheumatologists achieved a consensus on the tools to be used for such monitoring after a presentation of a systematic literature review (consensual meeting).

Methods

The medical chart of out-patients seen by rheumatologists (office-based or hospital-based) have been checked by an independent investigator. The patients had to have visited twice the same rheumatologist within one year (within six months before and after the consensual meeting) to be retained for this analysis For each visit, the existence of the following informations in the medical chart (BASDAI score, CRP, ASDAS score) were collected.  

Results

In total, 456 medical charts issued from 228 patients (mean age: 44.6 (±12.6) years old, 147 (64.5%) males, mean disease duration: 11.7 (±10.7) years) who visited 23 rheumatologists (9 (39.1%) hospital-based and 14 (60.9%) office-based, mean age 51.6 (±10.3) years old and with 22.2 (±10.1) median years of practice of rheumatology), visiting a mean of 62 (±37.1) patients per week of whom 17.8% were diagnosed with axial spondyloarthritis) were reviewed.

Before the consensual meeting, the frequency of reported tools in the medical chart was 65 (28.5%), 117 (51.3%), 38 (16.7%) and 2 (0.9%) for BASDAI, CRP, BASDAI and CRP and ASDAS respectively. After the consensual meeting, these frequencies changed to 118 (51.7%), 119 (52.2%), 72 (31.6%) and 14 (6.1%) respectively.

An increase in the frequency of the reported tools, was more frequently observed in office-base rheumatologists (e.g. BASDAI score from 32 (23.2%) to 70 (50.8%) medical charts, before and after the consensual meeting, respectively).

Conclusion

This study suggests that 1) despite existing recommendations, tools permitting the evaluation of disease activity are not frequently collected in daily-practice and 2) a reminder through regular meetings could be considered in order to improve this situation.

Reference

[1] Smolen et al. Treating spondyloarthritis, including ankylosing spondylitis and psoriatic arthritis, to target: recommendations of an international task force.  Ann Rheum Dis. Jan 2014; 73(1): 6–16

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/only-30-rheumatologists-collect-basdai-in-patients-with-axial-spa-in-daily-practice-the-potential-role-of-a-consensual-meeting-to-improve-it/