Knowledge, Awareness, and Attitudes Regarding Axial Spondylarthritis Among Nonrheumatology Physicians in the United States.

Abstract

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

Methods: An online questionnaire was distributed nationwide to nonrheumatology physicians (NRPs) serving patients with chronic back pain (CBP), namely in family/internal medicine, spine surgery/orthopedics, pain management, physical medicine/rehabilitation, and to rheumatologists as the comparator group.

Results: Seven hundred fifty physicians completed the survey (response rate 24%). The majority of NRPs were familiar with inflammatory back pain (IBP); 87% could identify > 4 of 8 IBP items, but only 41% routinely assess for IBP in practice. NRPs screen patients for axSpA risk factors ≤ 50% of the time. NRPs order C-reactive protein and HLA-B27 tests significantly less often, and antinuclear antibodies and rheumatoid factor tests significantly more often than rheumatologists in patients with CBP. Only 50% of NRPs correctly answered sacroiliac/pelvic radiograph as the correct initial imaging test, and 37% correctly selected magnetic resonance imaging of the pelvis as the next imaging test. Unfamiliarity with the terms axSpA and nonradiographic axSpA was reported by 11% and 35% of NRPs, respectively, and NRPs less often consider axSpA as a possible diagnosis in patients with CBP. Formal referral guidelines for patients with suspected axSpA were felt to be important by NRPs and rheumatologists alike.

Conclusion: There is a substantial lack of knowledge and awareness about nomenclature, laboratory testing, and proper imaging of axSpA among NRPs. Unnecessary laboratory tests are commonly ordered by NRPs and rheumatologists. Formal referral guidelines and improved education may help reduce diagnostic delay of axSpA.