Background/Purpose: A survey was conducted to better understand the characteristics and management of axSpA and patient and physician perspectives on current treatment.

Methods: In March 2024, data were extracted from a large, cross-sectional Disease-Specific Programme^TM survey, which was initiated in June 2023 in France, Germany, Italy, Spain and the UK. Rheumatologists were asked to complete an online survey for their next 8 consecutive adult patients with axSpA (4 with radiographic [r]- and 4 with non-radiographic [nr]-axSpA). The same patients could voluntarily and independently complete a survey, allowing physician- and patient-reported data to be matched. Surveys covered clinical status, treatment decisions, preferences and satisfaction. All analyses were descriptive.

Results: Rheumatologists (N=276) provided data on 988 patients with r-axSpA and 981 with nr-axSpA. Patient-reported data were available for 265 r-axSpA and 222 nr-axSpA patients. Mean disease duration was 7.3 years for r-axSpA and 4.5 years for nr-axSpA. At diagnosis, moderate or severe disease was reported in 90% of patients with r-axSpA and 85% of those with nr-axSpA; at data collection, 26% of patients in each group had moderate or severe disease. The proportion of patients with deteriorating r-axSpA/nr-axSpA reduced from 84%/83% at diagnosis to 7%/9% at data collection (Fig 1). At data collection, the most common symptoms/features were morning stiffness, sacroiliitis, fatigue and pain (17–35%); 9% of patients were experiencing current flares. On average, patients had 3.9 consultations in the last 12 months.   

Patient–physician matched data (N=477) showed rheumatologists perceived axSpA as less severe than patients did, reporting severe disease for 3% of patients, versus 6% reported by patients.

Rheumatologists stated they followed treatment recommendations, predominantly ASAS-EULAR, for ~60% of patients. 76% of patients were on advanced therapy (AT), most commonly TNF inhibitors (72%), followed by IL-17 inhibitors (16%) and Janus kinase inhibitors (10%). The most frequent reasons for prescribing current treatment were control of acute episodes/flares (51%) and good overall safety profile (51%). Matched data (N=483) showed patients and rheumatologists mutually agreed that treatment decisions were shared in 62% of individual cases.

Most patients with r-axSpA (88%) and nr-axSpA (82%) were satisfied with current treatment; rheumatologists were satisfied for 92% and 90% of patients, respectively (Fig 2). Rheumatologists were very satisfied with current treatment for a higher proportion of AT-naïve versus AT-experienced patients (45% vs 31%); amongst patients, 31% (AT-naïve) and 30% (AT-experienced) were very satisfied. The most common reasons for rheumatologist dissatisfaction were lack of efficacy overall (44%), lack of pain control (32%) and fatigue (20%) (Fig 3).

Conclusion: In this cross-sectional study, rheumatologists reported following treatment recommendations for ~60% of patients, and most patients were involved in treatment decisions. Treatment dissatisfaction was reported by rheumatologists and patients for a minority of patients; amongst rheumatologists, this was most often due to lack of efficacy, pain or fatigue.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/current-disease-management-and-treatment-satisfaction-in-axial-spondyloarthritis-axspa-in-europe-patient-and-rheumatologist-perspectives/