Dr. Mohammed Bedaiwi

Dr. Mohammed Bedaiwi is the head of Rheumatology division in King Saud University in Riyadh. He is an Assistant Professor and Consultant Rheumatologist.

Barriers in the management of axial spondyloarthritis

The management of axial spondyloarthritis (axSpA) is challenging worldwide, Early diagnosis and intervention for patients with axSpA has the potential to improve clinical outcomes as well as patients’ quality of life.
There are several reasons for these challenges, including limited awareness of the disease manifestations and prevalence in some region among physicians and patients, Primary care physicians sometimes have limited knowledge of axSpA, leading to a lag time in the referral of patients with low back pain to a rheumatologist. the concept of non-radiographic axSpA may not be well-understood by the referring physicians.
Another main challenge could be the late and costly access to magnetic resonance imaging “MRI” and this may have a large impact on early diagnosis especially in the early axial case which needs MRI as a primary tool of diagnosis although, in some cases It can be challenging for rheumatologists and radiologists to interpret MRI findings suggestive of sacroiliitis and variation among readers is common.
Other challenges related to axSpA management include lacking country-specific treatment guidelines and possible economic and awareness level which may affect patients’ attempts to seek and continue treatment.
Patients with joint pain are often managed by orthopaedic specialists also, In some regions there is a shortage of rheumatologists and patients may have a long wait for an appointment. Patients with fewer socioeconomic resources may consult a pharmacist rather than a physician and purchase nonprescription NSAIDs to manage pain. Also, patients may self-treat with traditional approaches, such as herbal treatments or traditional therapies. Some patients may seek care from other specialties, such as orthopedics, neurology, or neurosurgery, believing that such specialists are experts in treating back pain.
Other challenging issue after reaching the final diagnosis of (axSpA) is the Patients who are not well-informed about chronic autoimmune conditions may interpret the treatment plan of axSpA after reaching the remission status.
The association between HLA-B27 and axSpA appears to be lower among some populations which could delay the diagnosis in case of unavailability of radiographic tools. Thus, the HLA-B27 antigen test may be expensive, have limited availability, and/or prove less useful in diagnosing axSpA in this region
In some areas, access to healthcare varies according to socioeconomic status. Therefore, it is important for clinicians to minimize the lag time between diagnosis and disease management in these patients. Additionally, local or country treatment pathways should be developed that leverage the most cost-effective therapies at the appropriate stage of the disease, in order to maximize the benefit for all patients.
Categories: Rheumatology

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