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THU0405 Ability of General Practitioners To Distinguish between Inflammatory and Non-Inflammatory Symptoms in Patients at Risk of Spondyloarthritis: The AppSpA Study
  1. M.C. Karreman1,2,
  2. J.M. Hazes1,
  3. A.E. Weel1,2
  1. 1Rheumatology, Erasmus University Hospital
  2. 2Rheumatology, Maasstad Hospital, Rotterdam, Netherlands


Background Over the last couple of years early arthritis clinics provided quick access for patients with inflammatory arthritis. However, although early access to specialized care is now available, adequate referrals are also required to shorten the doctors' delay. Therefore, general practitioners (GPs), the ones who refer, should be aware of symptoms distinguishing between inflammatory and non-inflammatory disease in patients at risk for spondyloarthritis (SpA).

Objectives To describe GP's ability to recognize symptoms suggestive of spondyloarthritis.

Methods The AppSpA study was set up, a cross-sectional study focusing on awareness and knowledge of SpA in GPs and patients at risk for SpA. For the present study a single survey was developed and send out to GPs in various regions of the Netherlands. This survey was based on a study by Jois et al, which looked into recognition of symptoms of inflammatory back pain. Since we were also interested in the ability of GPs to recognize peripheral manifestations of SpA, we added some extra questions.

Results 183 of the 950 GPs completed the survey, leading to a participation rate of 19.3%. Of the participating GPs the mean age was 47.2 years (SD 10.3) and 47.5% were male. Mean time working as a GP was 15.4 years (SD 13.5).

Almost all GPs (94.5%) indicated to be familiar with the term SpA, but 55.5% associated it only with axial manifestations. Up to one third of the GPs associated the term SpA with psoriatic arthritis (23.7%) and Inflammatory Bowel Disease (33.5%).

With regard to the recognition of signs of inflammatory pain, especially morning stiffness and pain relieve by NSAIDs were recognized (Table 1), whereas pain improvement with exercise was recognized in less than 25% of cases. When we focus on the peripheral manifestations of SpA; out of six signs for inflammatory peripheral disease, only 43.2% of GPs recognized at least three of these symptoms. For the eight axial signs, 60.6% recognized at least four symptoms.

If GPs thought about inflammatory symptoms, the majority asked for the presence of psoriasis (83.6%) and inflammatory bowel disease (72.1%). GPs less often ask about other SpA related symptoms such as uveitis (61.8%), enthesitis (19.1%) and dactylitis (19.1%).

Conclusions Overall, recognition of inflammatory disease by GPs is suboptimal, where GPs are more aware of axial manifestations compared to peripheral manifestations. The recognition of these signs and symptoms of SpA in primary care needs improvement in order to facilitate the necessary referrals to rheumatologists.

Acknowledgement This survey is part of initiative to develop a communication platform which was financially supported by AbbVie.

Disclosure of Interest None declared

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