¹Khalid Abdalla Alnaqbi,² Tariq Al Araimi, ³Samar Al Emadi, ⁴Hanan Al Rayyes, ⁵Khuloud Saleh, ¹Khlood Bashir, ⁷Xenofon Baraliakos

¹Tawam Hospital, ²Royal Hospital, ³Hamad General Hospital, ⁴Prince Sultan Military Medical City, ⁵Farwaniya Hospital, ⁶Tawam Hospital, ⁷Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum

Background:

There are many challenges in the referral, diagnosis, and management of patients with suspected axial spondyloarthritis (AxSpA) worldwide. Gulf-REDMAS comprises a group of expert rheumatologists from the Gulf countries who convened to create and disseminate a survey to understand the aforementioned challenges with the main aim to fill the evidence gap.

Material(s) and Method(s):

An anonymous online survey consisting of 35 multiple choice closed questions that lasted for 1 month was circulated among practicing rheumatologists in the Gulf countries (calculated sample size was 101).

Result(s):

One hundred thirty-two rheumatologists completed the survey from 371 rheumatologists in the region. The majority of responders (88%) noted that they faced delays in the referral of AxSpA patients to their clinic, with the main reason being a ‘lack of disease awareness by primary care physicians’ (56%). The survey respondents surmised that the leading reasons for non-rheumatology specialists’ reluctance to refer patients with suspected AxSpA included ‘lack of awareness of long-term complications of spondyloarthritis’ (34%), and ‘some non-rheumatology specialists think they can treat and diagnose AxSpA without the need to refer to a rheumatologist’ (28%). Two-thirds of survey respondents (66%) highlighted that the greatest challenge being ‘patients who present with atypical symptoms such as: <3 months back pain, chronic back pain occurring >45 years of age, or chronic back pain with ≥1 spondyloarthritis features but without sacroiliitis on imaging’ (51% of responders who highlighted they faced a challenge). The main patient-related challenges to management of AxSpA were: ‘patients cannot access the medication as it is unavailable in my hospital/clinic pharmacy’ (31%, first reason) and ‘patients may have fears of drug side effects (39.6%, second reason).

Conclusion(s):

Responses to this survey highlighted several challenges in the referral, diagnosis, and management of AxSpA patients. Future recommendations that should be implemented to address these challenges