Practice patterns and challenges in the referral, diagnosis, management, and monitoring of axial spondyloarthritis: insights from an online survey of rheumatologists

Abstract

There is a dearth of literature exploring challenges faced by rheumatologists in the referral, diagnosis, and management of patients with suspected axial spondyloarthritis (axSpA) worldwide. Our study aims to understand such challenges faced by rheumatologists in the Gulf countries. A cross-sectional online survey was conducted among practicing rheumatologists using 35 close-ended questions. Items underwent refinement using a sensibility assessment, pilot-tested and followed international survey reporting guidelines. A total of 190 responses were received and analyzed. Most respondents were consultants (68.1%), practiced in tertiary governmental hospitals (52.7%) and located in urban settings (95.1%). A majority (88.6%) reported delayed presentation of axSpA patients. Orthopedists, family physicians, and internists were among the top referring specialties. Half of respondents believed that non-rheumatology specialists are reluctant to refer their axSpA patients to a rheumatologist. Diagnostic challenges were reported by 65.5% of respondents and only 28.8% experienced difficulty ordering or interpreting HLA-B27. The majority (76.6%) had access to a musculoskeletal radiologist to read X-rays and MRIs. Difficulties in tracking patient-reported outcomes and physical examination findings were reported by 46.9% and 31.5% of respondents, respectively. Patient non-adherence due to fear of drug side effects (61.4%) or symptom improvement (60.0%) was a leading obstacle in terms of management. Only 12% had access to a rheumatology-trained nurse. This is the first study from the Middle East and North Africa region to explore clinical practices and challenges related to axSpA. The findings highlight the need for educational initiatives targeting non-rheumatologists to promote earlier referrals, greater use of disease metrics for monitoring, and the development of Gulf-specific management recommendations that emphasize multidisciplinary support.

Keywords: Axial spondyloarthritis; Cross-sectional studies; Disease management; Physician’s practice patterns; Referral and consultation; Rheumatologists; Surveys and questionnaires.