Axial spondyloarthritis treatment recommendations and disease activity monitoring in clinical practice - results of an online survey.

OBJECTIVE: Clinical practice guidelines are not always followed consistently. To better understand potential barriers to the implementation of treatment recommendations in axial spondyloarthritis and ankylosing spondylitis (axSpA/AS) an online survey was performed.

METHODS: Email invitations were sent to US rheumatology care providers in January 2023. The questionnaire included 20 questions with an estimated completion time of 5-7 minutes.

RESULTS: 104/441 (23%) invitees participated including 80/104 (77%) board-certified rheumatologists and 20/104 (19%) fellows. Survey participants identified UptoDate (85%), treatment guidelines (74%) and colleagues (54%) as relevant sources of knowledge for managing axSpA/AS. 64% and 53% of participants considered themselves to be at least moderately familiar with the ACR/SAA/SPARTAN and ASAS/EULAR treatment recommendations for axSpA/AS, respectively. While 69% of participants agreed or strongly agreed that disease activity scores are useful for making treatment decisions in axSpA/AS, only 37% measure patient-reported outcomes (PROs) frequently (≥ 50% of clinic visits) while 82% do so for CRP/ESR. PROs are typically recorded during clinic encounters (65%) and CRP/ESR are obtained after the visit (86%). 57% and 47% of participants considered BASDAI and ASDAS to be at least moderately useful for measuring disease activity in axSpA/AS, 41% and 37% thought the same about ASAS20 and CDAI.

CONCLUSION: Treatment guidelines are an important resource for rheumatologists managing patients with axSpA/AS. Although there is general agreement that disease activity monitoring is important, the implementation of the respective recommendations is lacking. Reasons may include lack of familiarity and an underdeveloped infrastructure to efficiently collect PROs.