Background Epidemiology data on inflammatory back pain (IBP) prevalence within the UK is still lacking. Previous studies from the UK show delay in diagnosis of IBP for up to 8 years. This is partly due to lack of awareness among Public and Primary care practitioners. New criteria have been developed to identify conditions at an early stage with a view to reducing times to referral. Our previous work, using social media, helped identify patients with IBP. New IBP classification criteria were applied to the identified patients in the present analysis.
Objectives To follow up IBP positive patients over a twelve month period to see how their back pain had changed, whether treatment was actively sought and what treatment(s) were provided.
Methods A cross-sectional survey was carried out between December 2013 and May 2014 to identify adults (≥18 years) who had IBP. Recruitment was targeted in a novel way to enlist UK participants using social media (Facebook) and national newspaper (Daily Mail) advertisements. Online questionnaire-based surveys supplemented by telephone response were completed. Those participants who fulfilled either the ASAS or Calin criteria at the initial assessment were offered an information leaflet on IBP. The participants were also asked to complete follow-up questionnaires at 6 and 12 months.
Results A total of 586 participants completed the initial survey; of these, 304 (51.87%) satisfied either the ASAS or Calin criteria for IBP. Many patients at both 6 and 12 months follow-up reported that their back pain was unchanged, with more reporting a decline (37% of responses) than an improvement (31% of responses). Evaluation of changes in quality of life using mean EQ5D scores also suggested a small deterioration.
Of the 91 patients who completed a follow-up questionnaire at 6 months 57 (63%) had seen a GP, 6 (7%) had seen a rheumatologist, 16 (18%) had physiotherapy and 8 (9%) were finally diagnosed with a spondyloarthropathy (eg. Ankylosing Spondylitis). Of the 67 patients who completed a follow-up questionnaire at 12 months 41 (61%) had seen a GP, 5 (7%) had seen a rheumatologist, 13 (19%) had physiotherapy and 9 (13%) were finally diagnosed with a spondyloarthropathy. Only 1 patient (1.5%) at 12 month follow-up (none at 6 month follow-up) had received biologic treatment with anti-TNF.
Of the 91 patients who completed the 6 month follow-up questionnaire only 28 downloaded the IBP information leaflet and no new IBP diagnoses resulted.
Conclusions Patients who were IBP positive (ASAS or Calin) in an online survey, many recruited using social media, deteriorated slightly over a 12 month follow-up period. Providing these IBP positive participants with a link to an information leaflet did not result in any new IBP diagnoses. Although most patients had seen a GP, only 7% had seen a rheumatologist despite fulfilling the IBP criteria. Primary care education on IBP is key in the early diagnosis of Spondyloarthropathy.
Acknowledgement This study was sponsored by AbbVie and financial support for the study was provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the abstract.
The authors wish to thank Bobby Brown, who supported this work as a medical writer and Patients Direct, who designed and conducted the study.
Disclosure of Interest None declared