Rheumatologists are not uniformly following recommendations on axial spondyloarthritis disease assessment and monitoring, survey finds
Presenter: Stephanie Sinnappan, Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA.
Where Are We with Implementing Axial Spondyloarthritis Treatment Recommendations and Disease Activity Monitoring in Clinical Practice – Results of an Online Survey Amongst Rheumatology Care Providers. Abstract 1385. Presented Nov 13, 2023.
Not all rheumatologists are following recommendations for ongoing disease measurement and monitoring of patients with axial spondyloarthritis and ankylosing spondylitis (axSpA/AS), according to survey results reported at ACR Convergence 2023.
“Although there is general agreement that disease activity monitoring is important, implementation of the specific guideline recommendations is lacking,” said study author Stephanie Sinnappan of the Division of Rheumatology, Inflammation and Immunity at Brigham and Women's Hospital in Boston, MA.
Multiple treatment guidelines for axSpA/AS are available, including the 2019 update of treatment recommendations from the ACR, the Spondylitis Association of America (SAA), and the Spondyloarthritis Research and Treatment Network (SPARTAN).1 More recently, the 2022 update of recommendations for axSpA from the Assessment of SpondyloArthritis international Society (ASAS) and the European League Against Rheumatism (EULAR) was published.2
However, healthcare providers do not consistently follow clinical practice guidelines, Sinnappan and co-investigators noted in a poster presentation, adding that factors that may contribute to poor adherence may be the practice setting, the patient, the healthcare professional, societal factors, or the guideline itself.
To determine potential barriers to the implementation axSpA/AS treatment guidelines, the researchers conducted an online survey of rheumatology care providers in New England. The investigators developed a 20-question survey based on results of a focus group, then sent a link to the survey via email to healthcare providers in Connecticut, Massachusetts, Maine, New Hampshire, Rhode Island, and Vermont. The survey had an estimated completion time of 5 to 7 minutes.
Out of 441 surveys sent, 104 healthcare professionals (24%) participated. Of those respondents, 80 (77%) were board-certified rheumatologists and 20 (19%) were fellows. Approximately 70% reported working in academic medical centers, while 26% worked in hospital settings, group practices, or solo practices.
When asked to identify relevant sources of knowledge for managing axSpa/AS, 74% endorsed treatment guidelines, 85% identified the UpToDate decision support resource, and 54% said colleagues. Approximately 64% said they were at least moderately familiar with the ACR/SAA/SPARTAN guidelines, while 53% said they were at least moderately familiar with the ASAS/EULAR recommendations.
The ACR/SAA/SPARTAN guidelines recommend use of a validated AS disease activity measure at regular intervals, as well as consistent monitoring of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).
While 69% of respondents agreed or strongly agreed with the statement, “disease activity scores provide useful information for making treatment decisions in axSpA/AS,” only 38% said they measure patient-reported outcomes frequently (defined as during at least half of clinic visits), and 82% said they measure CRP and ESR frequently.
In addition, 63% said they typically recorded patient-reported outcomes during clinic encounters, while 86% said they obtained CRP and ESR after the clinic encounter, according to survey results presented at the meeting.
When asked about the utility of specific scores to measure disease activity in patients with axSpA/AS, 57% and 47% of respondents said BASDAI and ASDAS, respectively, were at least moderately useful, while 41% thought the same about the ASAS20 response. BASDAI and ASDAS were considered to very or extremely useful by 20% and 13%, respectively.
Potential reasons for the lack of adherence to clinical practice recommendations could include lack of familiarity with the guidelines or an underdeveloped infrastructure to efficiently collect patient-reported outcomes prior to clinic visits.
“Guideline uptake and implementation should be considered in future updates of axSpA/AS treatment recommendations,” Sinnappan said.
The survey emails were sent to providers in January and February of 2023. Prospective participants were randomized to a study incentive or control group. Those in the incentive group received emails noting that the investigators would donate $25 to the Spondylitis Association of America for every completed questionnaire.
The response rate was 24% overall, 22% in the incentive group, and 25% in the control group.
Disclosures
Stephanie Sinnappan reported no financial disclosures related to the study.
References
- Ward MM, Deodhar A, Gensler LS, et al. 2019 Update of the American College of Rheumatology/Spondylitis Association of America/Spondyloarthritis Research and Treatment Network Recommendations for the Treatment of Ankylosing Spondylitis and Nonradiographic Axial Spondyloarthritis. Arthritis Rheumatol 2019; 71(10):1599-1613. doi:10.1002/art.41042
- Ramiro S, Nikiphorou E, Sepriano A, et al. ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis 2023; 82(1):19-34. doi:10.1136/ard-2022-223296