Background/Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are the keystone in the treatment of axial Spondyloarthritis (axSpA).  Diagnosis is often not easy in early forms due to the paucity of structural/inflammatory lesions and the clinical gestalt of the physician is an important part of the treatment decision in clinical. Our hypothesis was that NSAID prescription might be a reflection of the degree of the physician’s diagnostic confidence in inflammatory back pain (IBP) suggestive of axSpA.Our objective was a) to describe the population of IBP patients suggestive of axSpA that were almost never exposed to NSAID over 3 years and to compare such population to the exposed patients; b) to compare both groups with regard to the fulfillment of the ASAS criteria and physicians’ diagnostic confidence and c) to explore the correlation between NSAID intake and physicians’ diagnostic confidence.

Methods: Study design and patients: Observational prospective, multi-centre study (DESIR cohort) of patients with early IBP (>3 months and < 3 years symptom duration) suggestive of axSpA, and available data over 3 years.Diagnosis: ASAS axSpA criteria and physician’s diagnostic confidence in axSpA (from 0 to 10, where 10= highest confidence).NSAID intake: the almost never exposed (ANE) group was defined as the patients who had an ASAS-NSAID score < 5 at each visit over follow-up (e.g. patients who had received <6 days/6 months of diclofenac). The rest of the cohort was the exposed (E) group.Statistical analysis: by Chi-square and T tests and spearman correlation.

Results: Of the 606 patients, 26 (4.3%) patients were classified in the ANE group.  Patient and disease characteristics were comparable in both groups, except for history of inflammatory bowel disease (IBD): 6 (23%) vs. 17 (2.9%), in the ANE and E groups, respectively( p<0.001).Diagnosticconfidence: a) baseline: the percentage of patients fulfilling the ASAS criteria at baseline (and each arm) was similar in both groups (ASAS criteria :69.2% and 72.8%, for the ANE and E groups, respectively), as was the mean physician’s axSpA diagnostic confidence (7.1±2.6 and 7.1±2.5). A quite moderate correlation between physician’s axSpA diagnostic confidence and NSAID intake score was found (rho= 0.15, p=0.0002); b) at 3 years: no differences were observed in the fulfillment of the ASAS criteria (69.2% and 74.9%);no differences were observed either with regard to the mean physician’s axSpA diagnostic confidence at the end of follow-up, (8.11±2.5 and 7.8 ±2.8) and no correlation was found between the physician’s axSpA diagnostic confidence and the NSAID intake score (rho= 0.06, p=0.183).

Conclusion: Less than 5% of patients with IBP suggestive of SpA were almost never exposed to NSAID during follow-up; these patients did not differ from the rest of the cohort, except with regard to the presence of IBD. This suggests that lack of NSAIDs exposure is more driven by the presence of IBD than the lack of diagnosis confidence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-the-degree-of-nsaid-treatment-in-early-axial-spondyloarthritis-a-reflection-of-the-physicians-diagnosic-confidence-results-from-the-desir-cohort/