Background The average delay to diagnosis in the UK is 8.5 years, even though the majority of patients consult their GP within one year of symptom onset. The lack of awareness and recognition of IBP (Inflammatory Back Pain) is one of the main reasons for the unacceptable delay in diagnosis1. A public awareness campaign to raise awareness of IBP was held in Bath on 13th September 2014
Objectives The aim of the study was to assess referral rates pre and post campaign - number of referrals for IBP, number of newly diagnosed Axial Spondyloarthritis (AxSpa)/ Ankylosing Spondylitis (AS) and mechanical back pain patients who were referred with reference to IBP and for new AxSpa/AS patients - age, length to diagnosis from symptom onset, sex, HLA B27 status and CRP were also assessed.
Methods Referrals to the Royal National Hospital for Rheumatic Diseases (RNHRD), Bath Pre Campaign from January-March 2014 and Post Campaign in Months October-December 2014 were evaluated.
Referral letters were reviewed and categorised as either likely inflammatory referrals or likely non-inflammatory referrals. A referral was considered as inflammatory if it contained key words such as Sacroiliitis, HLA B27 status, mention of Family history of Ankylosing spondylitis/Axial spondyloarthritis, spondyloarthropathy or inflammatory back pain/arthropathy
Based on history and investigations, patients were classified using the ASAS Axial SpA classification criteria as either nr-AxSpa orAS, or if they didn't meet the criteria “Mechanical Back pain”. It was assessed whether this was a new or an old diagnosis.
Results There were 91 back pain referrals pre campaign and 96 post campaign.
Pre campaign, 40 patients with AxSpa were referred. 8/40 were diagnosed as new AS (20%) and 16 had known AS. 10/40 (25%) were diagnosed as new nrAxSpa. 6 had known nrAxSpA. Of the 18 new AxSpa cohort 14 had “inflammatory” referrals from the referrer. ie. 77% accurate referrals.51 cases of mechanical back pain were diagnosed; 19 of the referrals contained “inflammatory” key words
Post campaign,38 patients with AxSpA were referred. 3/38 were diagnosed with new AS. 11/38 were diagnosed with new nrAxSpa. 12/14 of new AxSpa patients had “inflammatory” referrals.ie 85% accuracy.
58 cases of mechanical back pain were diagnosed; 21 of the referrals had “inflammatory” key words.
Conclusions In a local setting, the campaign did not significantly increase the number of new back pain referrals to rheumatology. Reassuringly, we found that the index of suspicion from referrers for AxSpA to be high in both cohorts.
Hamilton L, Gilbert A, Skerrett J, Dickinson S, Gaffney K. Services for people with ankylosing spondylitis in the UK–a survey of rheumatologists and patients. Rheumatology (Oxford, England). 2011 Nov;50(11):1991–8.
Disclosure of Interest None declared