AB0729 ASSESSING THE DIFFERENCES IN TIMES TO GENERAL PRACTITIONERPRESENTATION AND DIAGNOSIS, AND OUTCOMES FOR AXIAL SPONDYLOARTHRITIS PATIENTS IN DIFFERENT ETHNIC GROUPS

Abstract

Background Axial spondyloarthritis (axial SpA) is a condition characterised by inflammatory back pain +/- extra-articular manifestations. There is a known delay to diagnosis1. Management includes physiotherapy, non-steroidal anti-inflammatory drugs (NSAIDs) and biologic agents2. The Luton & Dunstable University Hospital, UK Rheumatology department looks after an ethnically diverse population of patients with the condition. Objectives The objectives of this study were to compare time from symptom onset to General Practitioner (GP) presentation, time from symptom onset to diagnosis, and response to treatment between different ethnic groups. Methods 124 patients with an axial SpA diagnosis, according to the Luton & Dunstable University Hospital infoflex database, were identified. 24 patients were excluded due to a peripheral spondyloarthritis diagnosis. A retrospective case note review of 100 case records was undertaken. A Microsoft Excel spreadsheet was used to analyse data. Results The mean age was 44 years. 64 (64%) patients were male and 36 (36%) were female. 48 (48%) and 27 (27%) patients were HLA-B27 positive and negative respectively. HLA-B27 status was not available for 25 (25%) patients. Ethnicity breakdown showed 58 White British patients; 12 Pakistani; 7 White Other; 6 Bangladeshi; 5 White Irish; 5 asian; 4 indian and 3 Black Caribbean. There were 70 Caucasian (White British, Irish or Other) and 30 non-Caucasian patients. 49 patients (36 Caucasian and 13 non-Caucasian) had confirmed radiographic axial SpA. 17 patients (10 Caucasian and 7 non-Caucasian) had confirmed non-radiographic axial SpA. Based on available data for 57 patients, the median time of symptom onset to GP presentation was 48 months. Based on available data for 49 patients, the median time of symptom onset to diagnosis was 53 months. The mean time of symptom onset to GP presentation was 93 months in Caucasians compared to 66 months in non-Caucasians. The mean time of symptom onset to diagnosis was 91 months in Caucasians compared to 70 months in non-Caucasians. 12 patients presented within 1 year of symptom onset. Bath ankylosing Spondylitis Disease activity index (BASDAI) data were available for 7 out of 12 patients who presented within 1 year of symptom onset and 25 out of 45 patients who presented after 1 year. Following NSAIDs or biologics, there was a larger decrease in the first measured BASDAI for those who presented within 1 year of symptom onset (Mean BASDAI decrease: 2.77 compared to 2.06). For those presenting within 1 year of symptom onset, BASDAI data were available for 5 out of 7 Caucasian and 2 out of 5 non-Caucasian patients. The mean BASDAI decrease was 5.65 in non-Caucasian patients compared to 1.62 in Caucasian patients. For those presenting after 1 year of symptom onset, BASDAI data were available for 15 out of 26 Caucasian and 10 out of 19 non-Caucasian patients. Mean BASDAI decrease was 2.26 in non-Caucasian and 1.93 in Caucasian patients. BASDAI data were available for 43 out of 70 Caucasian patients and 18 out of 30 non-Caucasian patients, regardless of time of presentation. The mean decrease in first measured BASDAI was smaller in Caucasian patients compared to non-Caucasian patients (Mean BASDAI decrease: 2.49 compared to 2.66). Conclusion There is a shorter mean time of symptom onset to GP presentation and diagnosis in non-Caucasian patients compared to Caucasians. There is a higher response to treatment in patients who present within one year of symptom onset. This may support the hypothesis that early diagnosis leads to better outcomes.