AB0718 IDENTIFYING AXIAL SPONDYLOARTHRITIS IN THE UNITED STATES: A POSSIBLE ROLE FOR CHIROPRACTORS

Abstract

Background Approximately 19% of the general population in the United States has chronic back pain (CBP), with 5%-6% of these cases classified as inflammatory back pain (IBP).1 according to the US National Health and Nutritional Examination Survey, ≈ 15% of patients with IBP have axial spondyloarthritis (axSpA),1,2 which can cause irreversible structural damage in the spine, loss of function, and a decreased quality of life. The diagnosis of axSpA is commonly missed, as patients seek care for back pain (BP) from a variety of non-rheumatology providers, including chiropractors.3 Overall, nearly 50% of patients seek chiropractic care for BP.4 However, not much is known about the prevalence of different types of BP (acute, chronic, IBP, and BP due to axSpA) in patients seeking chiropractic care in the United States. Objectives To investigate the types of providers sought by patients with BP and the prevalence of acute BP, CBP, IBP, and axSpA in patients with BP seeking chiropractic care in the United States. A secondary objective was to investigate how frequently chiropractors refer patients with BP to a rheumatologist. Methods PubMed literature searches were performed for all English language articles published through December 2017 to determine which providers are sought by patients with BP as well as the percentage of patients with BP being referred to a rheumatologist following chiropractic consultation. Search terms included “chiropractic,” “chiropractor,” “axial spondyloarthritis,” “ankylosing spondylitis,” “inflammatory back pain,” “chronic back pain,” “acute back pain,” “low back pain,” “sacroiliac joint,” “sacroiliac pain,” “back pain epidemiology,” “rheumatologist,” and “rheumatology.” the full text of relevant articles was evaluated for specific data and BP statistics in this care setting. Results Only 7 articles that described the types of providers sought by patients with BP were identified (Table 1). Among patients with BP, 7%-45% sought chiropractic care; 26%-70% sought care from general practitioners, and 3%-37% sought care from rheumatologists. Patients who sought chiropractic care were mainly white, female, aged Conclusion Chiropractors, as primary spine care providers in the United States, are playing an increasingly larger role in the diagnosis and treatment of BP, with 7%-45% of patients with BP seeking chiropractic care. However, there are conflicting data on the types of BP treated by chiropractors in the United States. Nonetheless, since approximately 15% of patients with IBP have axSpA,1,2 it is very likely that many patients seeking care from chiropractors in the United States have undiagnosed axSpA. This reveals a need for a systematic investigation for the presence of axSpA among patients being treated by chiropractors. Specific educational strategies targeted to chiropractors should be applied to increase awareness of axSpA and achieve early referral to rheumatologists for these patients.