LAUSR

Background: ASAS-EULAR have developed management recommendations for axial spondyloarthritis (axSpA) to provide guidance to the management of patients with axSpA1. However, there is limited insight into how rheumatologists treat axSpA patients in daily clinical practice and if these recommendations are used. Objectives: To get insight into the management of axSpA patients in daily practice in the Netherlands. Methods: We performed a survey among rheumatologists in the Netherlands with 21 multiple choice questions; 5 general questions on characteristics of their practice and 16 questions addressing treatment and follow-up of axSpA patients in daily practice. The questionnaire was taken during structured face-to-face interviews by employees of the medical department of Novartis NL Rheumatologists in the Netherlands were invited to participate, aiming to get a sample of rheumatologists varying in geographical location and hospital type, as well as a mix of SpA-experts and non-SpA-experts. Rheumatologists gave approval for anonymous use of the data, which were entered in a database and analyzed using descriptive statistics. Results: Between October 15 2019 and January 16 2020, 36 rheumatologists participated; 6 from university hospitals, 27 from general hospitals and 3 from private care centers. 81% of the rheumatologists referred most of their axSpA patients (76-100%) after diagnosis for information and education concerning axSpA, exercise and lifestyle to a specialized nurse practitioner. Furthermore, 53% of rheumatologists referred most of their axSpA patients (76-100%) to a physiotherapist for exercise therapy. At diagnosis, approximately 55% of axSpA patients used the daily maximum dose of NSAIDs, compared to 25% for patients on biological treatment. The reported level of importance of different axSpA related aspects for starting a biological was largely similar for AS and nr-axSpA, although some differences could be observed (Figure 1): Most rheumatologists graded insufficient response to 2 NSAIDs during 4 weeks (94% for AS and 92% for nr-AxSpA) and bone marrow edema on MRI (75% and 89%) as important for starting a biological. About 60% of rheumatologists considered active disease using ASDAS/BASDAI important for the decision to start a biological, which was similar to the importance of the level of pain. For nr-axSpA, more rheumatologists graded elevated CRP and bone marrow edema on MRI as important for starting a biological, than for AS. Most rheumatologists (67%) do not base a decision that a biological is ineffective on ASDAS or BASDAI. To assess disease activity in axSpA, 86% of the rheumatologists always measured C-reactive protein (CRP), compared to 42% and 31% for BASDAI and ASDAS, respectively. 77% of rheumatologists reported to follow the 2016 ASAS-EULAR treatment recommendations for axSpA for treatment and follow-up of axSpA patients. Conclusion: This survey among Dutch rheumatologists suggests that ASDAS and BASDAI are as important for starting a biological in axSpA as is the level of pain. Moreover, in contrast to ASAS-EULAR treatment recommendations, most rheumatologists do not use validated disease activity instruments to assess biological ineffectiveness, which may be a topic for increasing awareness and education. References: [1]Van der Heijde D et al, Ann Rheum Dis 2017;76:978-91. Acknowledgments: We would like to thank all participating rheumatologists. Disclosure of Interests: Anneke Spoorenberg: None declared, Suzanne Arends Grant/research support from: Grant/research support from Pfizer, Reindert Bruin Employee of: Current employee of Novartis Pharma B.V., Marjolein de Hair Employee of: Current employee of Novartis Pharma B.V.