Background Whilst the burden of axial spondyloarthritis (axSpA) is well known, non-radiographic (nr)-axSpa has only recently been identified as a distinct spondyloarthritic indication with its own associated burden. As such, evidence demonstrating the clinical and healthcare system burden of illness is sparse.
Objectives To describe the clinical burden experienced by real world patients across Europe, including flaring, symptoms, disease severity, and remission. In addition, to demonstrate the impact of nr-axSpa upon country-specific healthcare systems.
Methods A retrospective database analysis drawing on data from the Adelphi Real World 2014 Rheumatology Disease Specific Programme (DSP®). The DSP is a cross sectional research programme collecting data from Rheumatologists and their patients in the UK, France, Germany, Spain, and Italy. Data were collected for 631 patients. Inclusion was based on physician diagnosis of nr axial SpA. Descriptive statistics were obtained to generate a profile of patients' clinical burden, measuring symptoms and flaring episodes over the past 12 months, disease severity prior to treatment, current pain assessment, remission status. All clinical outcomes were subjective physician-reported outcomes collected via questionnaire. Sub-group analyses were also conducted, between patients responsive and non-responsive to conventional and DMARD therapies, where response is measured by improvement in severity or absence of acute episodes following treatment, as reported by the physician subjectively.
Results The study cohort included 631 patients, 293 (49.8%) of whom were in remission. Males comprised 70.4% of the cohort, whose mean age was 41.7 years and mean age of symptom onset was 35 years, and 27.3% were classified as having moderate or severe disease severity. More than half of the patients (56.7%) were experiencing inflammatory back pain and 82.0% were experiencing at least some symptoms (e.g. inflammation, sacroiliitis, stiffness). Patients receive an average of 1.7 pharmacological treatments at any given time, while visiting their primary care provider and specialist an average of 1.6 and 2.5 times per year, respectively. On average, patients spent minimal time in the hospital, 0.1 nights per year. The clinical burden varied between countries, e.g. German patients were least likely to experience symptom flaring when compared to the aggregated EU average cohort (8.2% versus 16.4% EU). Reported inflammatory back pain ranged from 43.3% in Spain to 68.0% in Germany. Italian patients visited their primary care physician more frequently than in other EU countries (3.15 appointments per year versus 1.59 EU), and were least likely to receive biologic treatments (24.7% versus 36.1% EU). More than a quarter of nr-axSpA patients were identified as non-responsive to treatment (27.2%) and were more likely to experience flares (16.8% vs. 0%) and inflammatory back pain (86.6% vs. 47.1%) in contrast to treatment responders.
Conclusions Nr-axSpa patients suffer from various chronic and acute symptoms and associated pain, while a considerable proportion of patients were non-responsive to their nr axial SpA treatment. Inter-country patient management differences were observed, and may be associated with corresponding unmet clinical needs.
Disclosure of Interest R. Wood: None declared, T. Holbrook: None declared, C. Black: None declared, S. Kachroo Employee of: Merck