P001 The patient journey to diagnosis for axial Spondyloarthritis - The challenges in primary care and the positive impact of specialist axial SpA services

Abstract Background and aims The mean average time to diagnosis (TTD) in the UK for axial SpA is currently 8.29 yearsi. However, it should be possible to ensure diagnosis within 12 months of symptom onset to optimise clinical outcomesii. Current evidence suggests significant variability in the patient journey, particularly within primary care, where patients have repeat consultations for axial SpA related symptoms before being referred onward to rheumatologyiii. The National Axial Spondyloarthritis Society (NASS) TTD patient survey assesses where in the pathway patients experience most delays and the factors that may be driving these pinch points. Methods We developed a patient self-administered post-diagnosis axial SpA online survey form, and analysed the results along the pathway. Data were collected from 534 patients diagnosed since January 2021. Results The average time from first GP appointment to rheumatology referral was the longest wait, at 4.33 years (53% of the total delay). Other elements of the pathway were (mean): • 2.49 years (31%) from experiencing symptoms to seeking help from a GP, • 0.39 years (5%) waiting for a first rheumatology appointment following referral, • 0.88 years (11%) for the time from first appointment in rheumatology to formal diagnosis. Patients also reported seeing healthcare practitioners multiple times pre diagnosis. Physiotherapists (66%, n = 353) and GPs (63%, n = 337) were seen most frequently, with chiropractors (19%, n = 103) and osteopaths (17%, n = 93) seeing around a fifth of patients repeatedly. P001 Figure 1.Proportional split of average (mean) time to diagnosis by pathway. P001 Figure 2.Number of visits to other Health Care Professionals (HCPs) before receiving a formal diagnosis. Whilst specialist clinics are not possible everywhere, patients in these settings get a swifter diagnosis due to increased expertise, greater access to co-located MSK radiology services and expedited triage out of general rheumatology pools. References 1. Eddison J, et al. www.actonaxialspa.com; Webb D, et al. Act on axial SpA: A Gold Standard time for the diagnosis of axial SpA (2021); Al-Attar M, et al. Ann Rheum Dis 2021;80(Suppl 1):757.