title: Referral patterns, diagnosis, and disease management of patients with axial spondyloarthritis: results of an international survey.
abstract: BACKGROUND
  Recognition, diagnosis, and management of axial spondyloarthritis (axial SpA) continue to advance.
  
  
  OBJECTIVE
  The objectives of this study were to compare referrals, diagnosis, and management of axial SpA in Western Europe (WE), North America (US and Canada), and the rest of world (RoW) in academic and community rheumatology practices and to identify areas for further education.
  
  
  METHODS
  Rheumatologists responded online to the MAXIMA (Management of Axial SpA International and Multicentric Approaches) survey. Questions pertained to referral, diagnosis, and management of axial SpA.
  
  
  RESULTS
  Rheumatologists (N = 809) from 56 countries completed the survey about patients with chronic back pain (≥3 months) starting before age 45 years. Responses from academic and community practice rheumatologists were generally similar. Most referrals were from primary care providers. Symptom duration of 3 years or more at referral was reported more frequently by WE and RoW than US respondents. More WE and RoW than US rheumatologists referred to the Assessment of SpondyloArthritis International Society criteria for axial SpA in clinical practice. Rheumatologists reported prescribing disease-modifying antirheumatic drugs for the management of axial SpA. Sulfasalazine was frequently prescribed across regions; methotrexate was more commonly prescribed by US rheumatologists compared with other regions.
  
  
  CONCLUSIONS
  Referral patterns, diagnosis, and disease management for axial SpA were similar among WE, North America, and RoW rheumatologists and in academic/community practices, although more WE and RoW rheumatologists referred to Assessment of SpondyloArthritis International Society criteria in clinical practice. Disease-modifying antirheumatic drugs were commonly prescribed for axial SpA patients, although it was unclear whether these were prescribed for axial or peripheral symptoms.
authors.affiliation: From the *Leiden University Medical Center, Leiden, the Netherlands; †Charité Universitätsmedizin Berlin, Berlin, Germany; ‡University Hospital Gent, Ghent, Belgium; §Oregon Health & Science University, Portland, OR; and ‖AbbVie Inc, North Chicago, IL.
authors.forename: Désirée
authors.initials: D
authors.lastname: van der Heijde
authors.forename: Joachim
authors.initials: J
authors.lastname: Sieper
authors.forename: Dirk
authors.initials: D
authors.lastname: Elewaut
authors.forename: Atul
authors.initials: A
authors.lastname: Deodhar
authors.forename: Aileen L
authors.initials: AL
authors.lastname: Pangan
authors.forename: Alexander P
authors.initials: AP
authors.lastname: Dorr
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003153:Community Health Services / Q000706:statistics & numerical data; D019468:Disease Management; D005060:Europe; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D038622:Internationality; D008159:Lumbar Vertebrae / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009656:North America; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011379:Prognosis; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012219:Rheumatology / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012446:Sacroiliac Joint / Q000503:physiopathology*; D012720:Severity of Illness Index; D025241:Spondylarthritis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents