LAUSR

Background Ankylosing spondylitis (AS) patients have a significant delay between symptom onset and disease diagnosis, reaching on average 7 to 10 years in developed countries. Understanding the reasons behind this delay is essential to reduce the individual and socio-economic burden of the disease. Objectives To assess knowledge and perceptions of Portuguese family physicians (FP) towards AS and determine whether these contribute to the diagnostic delay at the primary care level. Methods The Assessment of REsults in Ankylosing spondylitis (arEA) study was developed by the NOVA-Information Management School (Lisbon) in collaboration with the Portuguese Society of Rheumatology, the Portuguese Association of Family Physicians (APMGF), the National Association of Primary Care Units (USF-AN), the National Association of AS Patients and the Portuguese League Against Rheumatic Diseases. The arEA aimed at assessing reasons for delayed diagnosis of AS, as well as disease impact in patients‘ lives, global health and work. A comprehensive online survey was developed and sent to FP associated with APMGF and USF-AN, collecting data on demographics, global knowledge and diagnostic and treatment attitudes towards AS. Results 91 FP responded the survey, 51.6% female, more frequently from the 25-44 year-old age group, half of which with <5 years of clinical experience. Most FP (70%) did not consider AS to be a relevant disease in everyday clinical practice but recognized (90%) there was a delay in diagnosis (5 years on average). Nevertheless, knowledge over AS was adequate. On average, prevalence was considered to be 56 cases per 1000 persons (close to the actual prevalence of 47 cases per 1000 persons reported in the epidemiological study EpiReumaPt). When assessing a patient with suspicious AS, the most valued symptoms/signs were inflammatory back/buttock pain, extra-articular manifestations (uveitis, enthesitis, dactylitis, psoriasis) and sacroiliitis on imaging (4.1, 3.9 and 3.9 on a 1-6 scale, respectively); 92.5% of FP refer the patient to a hospital consultation, rheumatology in 88.5% of cases; 37.5% of FP initiate treatment, with NSAIDs in 81% of cases. A mean delay of 9 months between patient referral and first hospital consultation was also reported (>1 year in 22%). In 73.4% of cases, no specific referral protocol exists for AS or other rheumatic inflammatory conditions; 33.8% of FP felt that the development of such protocol would improve access, while 36.8% considered that a rheumatologist acting as consultant in primary care units would facilitate identification and referral of inflammatory conditions. Conclusion Portuguese FP reported significant delay in hospital consultation after referral of suspicious AS cases. They apparently had good knowledge of AS, though responses may have been influenced by a younger, more updated and willing-to-participate physician population (selection and response bias). Disclosure of Interests None declared