Background/Purpose: There is significant discrepancy between population and diagnostic prevalence of axial spondyloarthritis (axSpA) and ankylosing spondylitis (AS) in the US. Delayed and missed diagnosis of axSpA in clinical practice may result from lack of timely referral by non-rheumatologists. Primary care providers (PCPs) are the main source for referral of back pain patients to rheumatologists in the US. In this study, we aim to assess knowledge, awareness and attitudes about axSpA among PCPs to identify gaps in knowledge and devise strategies for early referral.

Methods: In this ongoing study, we distributed a HIPAA compliant secure electronic survey created through Yale Qualtrics Survey tool to select PCPs within several academic institutions and affiliated practices. Our survey includes questions on demographics, practice setting, practice patterns and knowledge assessment surrounding axSpA.

Results: One hundred and thirty-eight providers completed the survey, with response rate of 40%. Among respondents, 68% were female, 76% MDs and 24% advanced practioners. Practice setting included 21% in academic practice and 46% in multi-specialty group. PCPs at different stages in their careers were surveyed. Twenty two percent saw < 30 patients/week, 55% saw 30-60 patients/week and 22% saw 61-90 patients/week. Ninety six percent were at least somewhat familiar with the term inflammatory back pain (IBP). Fifty eight percent reported that they never or rarely assess for IBP; 40% reported that they are not comfortable with making the diagnosis of IBP. Majority (83%) never or rarely ordered HLA B27, and 65% never or rarely ordered CRP for young patients with chronic back pain. Seventy six percent ordered X-ray lumbar spine at least often, and 54% rarely or never ordered MRI lumbar spine in chronic back pain patients. Seventy two percent rarely or never ordered X-ray sacroiliac joint and 97% rarely or never ordered MRI sacroiliac joint. At least fifty percent reported that they never or rarely asked about peripheral arthritis, psoriasis or inflammatory back pain, and at least 75% reported that they rarely or never asked about uveitis or enthesitis. Fifty percent of the providers reported that they never or rarely asked about family history of spondyloarthritis. Forty six percent were not familiar with the change in nomenclature around the terms axSpA and AS. Forty percent were not comfortable with making diagnosis of AS, and seventy percent were not comfortable with making diagnosis of AxSpA.

Conclusion: Our preliminary results confirm lack of knowledge and awareness regarding IBP and changed nomenclature of axSpA among PCPs. PCPs may not be evaluating chronic back pain patients for axSpA, which can contribute to lack of referral and delay in diagnosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/awareness-and-attitudes-regarding-axial-spondyloarthritis-among-primary-care-providers/