EP42 Delaying diagnosis: inflammatory back pain and the other features of suspected spondyloarthritis have been rarely featured in musculoskeletal health professions literature

Abstract

Abstract Background The diagnostic delays commonly experienced by many people with spondyloarthritis (SpA), particularly axial spondyloarthritis, is a global concern. Early diagnosis is important since earlier intervention supports better outcomes, responses to treatment and reductions in the many personal impacts. Although core knowledge within Rheumatology, research indicates that the key feature of inflammatory back pain and the signs, symptoms and risk factors for axial and peripheral SpA are under-recognised in primary care. This study investigated the prevalence within musculoskeletal health professional literature (physiotherapy, osteopathy, chiropractic) of the terminology, clinical features and risk factors that appear in recommended criteria to support suspicion of axial and peripheral SpA and referral to rheumatology. Methods A systematic search and bibliometric analysis was undertaken across databases and musculoskeletal professional literature sources until 30 September 2019 (see Table 1) . The search was applied to all text, without limits except English language where enabled. Occurrences of terms were identified and the literature sources graded as 'core', 'peripheral', 'minimally accessed', or 'beyond scope' of musculoskeletal health professions to reflect likely professional exposure to the sources. Results Only 22 journal articles were found with any of the searched terms within core musculoskeletal profession journals. Prevalence included 'inflammatory back pain' (2 articles), 'axial spondyloarthritis' (2 articles), 'spondyloarthropathy ' (12 articles), 'reactive arthritis (3 articles), 'oligoarthritis' (1 article), psoriasis (2 articles). Prevalence was significantly more predominant in peripheral journal specialties; rheumatology (5,967) including 'inflammatory back pain' (424 articles); orthopaedics, sports medicine, spine and pain (257 articles) and medicine/general practice (44). Conclusion This review highlights the significant lack of profile in musculoskeletal literature of inflammatory back pain as a clinical presentation, or other features that are key in suspecting axial and peripheral spondyloarthritis. This scarcity may contribute to limited awareness, knowledge and confidence of musculoskeletal health professions with screening for spondyloarthritis and a factor in delayed diagnosis. The findings suggest the importance of raising the profile of the features of suspected spondyloarthritis, inflammatory back pain and the other risk factors for axial and peripheral spondyloarthritis within global core musculoskeletal literature to support screening for SpA to become routine in musculoskeletal clinical practice. Disclosures: C. McCrum: Honoraria; Novartis.