To identify the proportion of patients with clinically diagnosed ankylosing spondylitis (AS) who are managed by primary care physicians (PCPs), who may potentially benefit from specialist management, researchers from the University of Aberdeen, UK examined data from large databases in Scotland. They found that only about one-third of patients with AS were managed by specialists.

Researchers indicated that knowledge of the proportion of patients managed by PCPs vs rheumatologists has important implications for future health care planning. According to researchers, “a large ‘silent’ proportion of patients who may have serious pathology and would benefit from additional assessment in a specialist clinic [was identified]”.

The Primary Care Clinical Informatics Unit Research (PCCIUR), an electronic primary care database including approximately one-third of the Scottish population, was utilized to examine the numbers of patients with AS being managed by PCPs. Patients with AS were identified via Read Codes. 

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To identify patients with AS being managed by rheumatology specialists, researchers utilized the Scotland Registry for Ankylosing Spondylitis, which contained data on patients with clinically diagnosed AS who were >15 years old, and seen in rheumatology clinics between 2010 and 2013. 

To estimate prevalence rates, the adult Scottish 2011 mid-year population data was used as the prevalence estimate denominator for patients with AS being managed by specialists, while the PCCIUR was used for those being managed my PCPs. 

Researchers found that the prevalence of patients with AS being managed by PCPs was 13.4/10 000 (95% confidence interval [CI] 12.8, 14.0), while the prevalence of patients with AS being managed by specialists was 4.7/10 000 (95% CI 4.5, 4.9). 

Patients who were managed by rheumatologists were younger at time of diagnosis (mean age 35 vs 38, P<.001) and also more likely to have a past history of uveitis (34% vs 22%, P<.001), inflammatory bowel disease (12% vs 6%, P<.001) and psoriasis (14% vs 6%, P<.001).

Summary and Clinical Applicability

In the first study comparing simultaneous estimates of the prevalence of the management AS by PCPs and rheumatologists, researchers found that only approximately one-third of patients with clinically diagnosed AS in Scotland were being managed by specialists.

Limitations and Disclosures

Error may have been introduced while coding for the AS diagnosis into the database.  This study did not evaluate if AS management by a rheumatologist improved long-term disease outcomes in this population.

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Dean LE, Macfarlane GJ, Jones GT. Differences in the prevalence of ankylosing spondylitis in primary and secondary care: only one-third of patients are managed in rheumatology. Rheumatology (Oxford). 2016; Published online ahead of print June 27, 2016. DOI: 10.1093/rheumatology/kew228