Dr. Karl Gaffney on the impact of the delay to diagnosis in #axSpA

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#axSpA delay to diagnosis in the UK - estimates from prior studies

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https://twitter.com/rheum_cat/status/1318235472489971712?s=20

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Poor awareness of #axSpA among healthcare professionals

--among UK chiropractors: https://doi.org/10.1093/rap/rkz034
--among subspecialists: https://doi.org/10.1007/s10067-016-3305-y

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Inflammatory back pain: remember, "not a diagnosis but a concept to prompt physicians to consider #axSpA"

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Patients with extra-musculoskeletal manifestations (previously called EAMs): often seen in non-rheum specialty clinics, like ophtho, derm, GI. But often don't make it to rheum for evaluation, or there is a long delay.

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Remember: the CLASSIFICATION criteria for #axSpA should only be applied AFTER you've made the diagnosis.

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From last year's ACR: https://twitter.com/rheum_cat/status/1193881471443972096?s=20

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The pathway to #axSpA diagnosis is challenging.

Next: @LianneGensler with a case: 54 y/o woman, referred for SAPHO evaluation with a T7 lesion on spine MRI.

By history, doesn't quite sound like she has IBP. But how much does this matter in this clinical context?

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The T7 lesion: with bone marrow edema and vertebral erosion. This was suspicious for TB, but the biopsy was negative for infx.

Back to HPI: she had a h/o hip pain. Remember to get details on WHERE this pain is located.

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XR: no jt space narrowing or ankylosis of the SI joints

BUT, erosive sacroiliitis without bone marrow edema seen on the MRI

Diagnosis: #axSpA (OR could consider psoriatic spondylitis vs axial PsA)

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The classic Feldtkeller study: women had a longer diagnosis delay

Blurry slides, so I provided the original https://doi.org/10.1007/s00296-002-0237-4

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Redeker, et al on #axSpA diagnostic delay
https://doi.org/10.1093/rheumatology/kez090

The presence of psoriasis associates with a longer diagnostic delay

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Back to Dr. Gaffney for the spectrum of #axSpA

@clemenlpez et al, systematic review & meta-analysis on characteristics & burden of disease in r- vs nr-axSpA https://doi.org/10.1136/rmdopen-2019-001108

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. @LianneGensler citing Yi, et al's systematic review

Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review https://doi.org/10.1007/s40744-020-00194-8

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Dr. Gaffney: strategies to reduce delay to #axSpA diagnosis?

"promote yourself" (which I'm doing right now!)
rheum collaborations with MSK radiology
public awareness campaigns, such as from @NASS_ASone
online learning platforms for other clinicians
referral systems

Q&A:

spondyloarthritis -- useful to think of as an "umbrella"?

@LianneGensler: "Well, it depends on if you're a lumper or a splitter."

[ @AlisonBays ]

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How to make #axSpA diagnosis without diagnostic criteria?

LG: We need to be flexible w diagnosis. But can use terms of like "probable" or "definite" for a diagnosis

Gaffney: due to heterogeneity, complexity of this & other rheum conditions, not possible to have dx criteria

Q: Should structural changes on imaging be incorporated into @Official_ASAS classification criteria?

A: Good question -- this work is currently in progress

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https://twitter.com/rheum_cat/status/1325739911144673280?s=20

More in the spondyloarthritis community hub later today! #ACR20