Knowledge, Awareness and Attitudes Regarding Axial Spondylarthritis Among Non-Rheumatology Physicians in the United States.

Abstract

Objective: We systematically surveyed physicians in the United States to assess their knowledge, awareness, and attitudes towards axial spondyloarthritis (axSpA). The objective was to identify barriers for referral and opportunities for intervention to reduce diagnostic delay of axSpA.

Methods: Online questionnaire was distributed nationwide to non-rheumatology physicians (NRP) serving chronic back pain (CBP) patients namely family/internal medicine, spine surgery/orthopedics, pain management, physical medicine/rehabilitation and to rheumatologists as comparator group.

Results: 750 physicians completed survey (response rate 24%). Majority of NRP were familiar with inflammatory back pain (IBP) and 87% could identify >4 of 8 IBP items, but only 40% routinely assess for IBP in practice. NRP screen CBP patients for axSpA risk factors 50% of time or less. NRP order CRP and HLA-B27 significantly less often and ANA and RF significantly more often in CBP patients than rheumatologists. Only 50% of NRP correctly answered x-ray SI/pelvis as correct initial imaging test and only 37% correctly selected MRI pelvis as next imaging test. Non-familiarity with term axSpA and nr-axSpA was reported by 11% and 35% NRP respectively, and NRP less often consider axSpA/AS as a possible diagnosis in CBP patients. Formal referral guidelines for axSpA patients were felt important or very important by NRP and rheumatologists.

Conclusion: There is substantial lack of knowledge and awareness about nomenclature, lab testing, and proper imaging of axSpA among the non-rheumatologists. Unnecessary lab tests are commonly ordered in CBP patients by non-rheumatologists and rheumatologists. Formal referral guidelines and improved education may help reduce the diagnostic delay of axSpA.