Background Recognition of inflammatory back pain (IBP) is central to early diagnosis of ankylosing spondylitis (AS), as well as to that of axial spondyloarthritis (AxSpA), which has been introduced as a more inclusive term to make early diagnosis of AS possible in the absence of radiographic sacroiliitis. While AxSpA is a hot topic for practicing rheumatologists, it is not yet known to what extent the recent knowledge accumulated in this field has been communicated to the other specialties.
Objectives To assess the level of awareness of features of IBP and AxSpA among physicians, who are frequently consulted first by patients with low back pain, and also the referral and management behavior of those specialties in patients with IBP and AxSpA.
Methods Trained interviewers using a structured questionnaire performed face to face interviews with a total of 403 physicians, from six different regions of Turkey, which included orthopedists (n:202), family physicians (n:102), and neurosurgeons (n:99). In the first part of the interview, physicians were asked to tell the topics they question when interviewing patients with back pain. Then they were shown 10 questions relevant for inflammatory back pain, and asked to rank them, from 1 to 10, with 1 having the highest importance. In the second part of the interview they were asked, which laboratory tests and imaging modalities they order, when assessing patients with back pain. They were also asked if they would order any of the tests displayed to them when they think the patient has inflammatory back pain. In the next part of the interview the physicians' familiarity with the concept of AxSpA and their referral patterns and management strategies in this group of patients were evaluated.
Results The duration of back pain was the most frequent topic questioned by the physicians (68%). Other domains, such as the effect of activity and night/morning pain, which are relevant for diagnosing IBP were asked by only a small proportion of physicians, (15% and 14%, respectively). Duration of back pain was ranked as having the highest importance (mean rank: 2.5) and the history of NSAID use with the least importance (6.9). The majority of physicians stated that they don't request blood tests (64%) when evaluating patients with low back pain and they refer 24% of their patients. Suspicion of a rheumatologic disease is the reason for referral in 15% of those cases. The great majority of physicians (89%) expressed that they can make distinction between mechanical and inflammatory pain. When asked what tests they would order if the patient has IBP; the answers given were CRP (85%), ESR (72%), pelvic X ray (1%), MRI (9%) and HLA-B27 (10%). However when it is asked in multichoice format, then the corresponding figures changed dramatically: 97%, 92%, 80%, 75% and 32%, respectively. About half of the interviewed physicians admitted that they were not aware of the concept AxSpA.
Conclusions There is a great need, at least in Turkey, to increase awareness of the concept of AxSpA and its main clinical features among specialists who are likely to be the first physicians consulted by patients with back pain.
Disclosure of Interest None declared