title: Services for people with ankylosing spondylitis in the UK--a survey of rheumatologists and patients.
abstract: OBJECTIVE
  . To investigate the services offered to patients with AS in the UK in 2010.
  
  
  METHODS
  Two thousand non-health-care professional members of the National Ankylosing Spondylitis Society (NASS) were sent a questionnaire asking about their experiences surrounding diagnosis, treatment and access to therapies (response rate 40%). A separate questionnaire was sent to a consultant rheumatologist in every acute NHS trust in the UK, asking about services offered to patients with AS (response rate 68%).
  
  
  RESULTS
  Overall, there was a mean diagnostic delay of 8.57 years. Almost one-third (32.2%) of patients were not reviewed in secondary care. Non-attendance was associated with increasing age and longer disease duration. Twenty per cent of patients were taking anti-TNF drugs, but 18.8% of departments reported that their ability to give anti-TNF therapy was restricted (64% reported primary-care trust rationing and 14% lack of staff). Almost all rheumatology departments had access to MRI, but 70.9% still used X-ray radiographs as their first-line investigation. A minority (5.6%) of patients reported they had never seen a physiotherapist, but less than one-third could self-refer for treatment during a flare.
  
  
  CONCLUSIONS
  This is the first study to explore the services available to people with AS in the UK. Almost one-third of patients are not seen in rheumatology departments and therefore may be under-treated. For those who are seen, access to anti-TNF drugs and other therapies remains an issue.
authors.affiliation: Rheumatology Department, Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, UK. louise.hamilton@nnuh.nhs.uk
authors.forename: Louise
authors.initials: L
authors.lastname: Hamilton
authors.forename: Annie
authors.initials: A
authors.lastname: Gilbert
authors.forename: Jane
authors.initials: J
authors.lastname: Skerrett
authors.forename: Sally
authors.initials: S
authors.lastname: Dickinson
authors.forename: Karl
authors.initials: K
authors.lastname: Gaffney
mesh_terms: D000328:Adult; D042241:Early Diagnosis; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D011788:Quality of Life / Q000523:psychology; D013167:Spondylitis, Ankylosing / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D006113:United Kingdom; D055815:Young Adult