Services provided for axial spondyloarthritis patients by rheumatologists in India: a survey

Objective We sought to evaluate the current knowledge and attitudes of Indian rheumatologists concerning axial spondyloarthritis (axSpA) with respect to recent terminology for diagnosis, management strategies and additional services. Methods The survey was designed for spondyloarthritis care given by rheumatologists in the Indian health-care context. The structured survey consisted of a combination of multiple-choice and open-ended questions. An anonymous Web-based questionnaire was sent to 710 members of the Indian Rheumatology Association, and descriptive analysis of responses was done. Results The survey respondents were from government and private health-care facilities and gave a response rate of 19% (133 of 710). About 49% of respondents were using the terminology axSpA for a new diagnosis of spondyloarthritis (SpA). BASDAI was used routinely as the main disease monitoring tool by most respondents (76.2%). Same-day MRI was available to 42.9% (51 of 119) respondents. Selective cyclooxygenase-2 inhibitors were the preferred first NSAID for 50% of respondents, and SSZ was the most preferred DMARD for peripheral arthritis. Financial constraints were the most common factor that affected the initiation of biologics and also the most common reason for stopping biological therapies. Nearly 65% (80 of 122) of respondents did not have a multidisciplinary team available in clinical practice, and only 15% of respondents had access to patient support groups. Conclusion For a new diagnosis, the terminology of axSpA is not fully accepted by Indian rheumatologists. The axSpA management given by Indian rheumatologists is in agreement with recent guidelines, however, there is a significant lack of accessibility to multidisciplinary care and patient support groups in India.