Survey of Thai Physicians Regarding Recognition and
Management of Inflammatory Back Pain and
Spondyloarthritis
Mintra Tangrungruengkit MD*,
Varalak Srinonprasert MD**, Praveena Chiowchanwisawakit MD*
Affiliation :
* Division of Rheumatology, Department of Medicine, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
** Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital,
Mahidol University, Bangkok, Thailand
Objective : To assess recognition and management of inflammatory back pain (IBP) and spondyloarthritis (SpA) among
non-rheumatologists (NRs) and rheumatologists in Thailand.
Material and Method: A cross-sectional survey was conducted among physicians in Thailand. A questionnaire designed
to evaluate knowledge regarding IBP and SpA was sent to 1,336 NRs. A different questionnaire regarding SpA management
in practice was sent to 112 rheumatologists.
Results : Of 1,448 questionnaires distributed, 367 (25.3%) questionnaires were returned (NRs: 321 [24.0%] and included
rheumatologists, 46 [41.1%]). Among NRs, 26.6%, 20.9%, and 9.4% recognized all features of IBP, according to Calin,
Assessment of SpondyloArthritis International Society, and Berlin criteria, respectively. In the presence of typical features
of ankylosing spondylitis, 57.8% of NRs made the correct diagnosis. Regarding related clinical skills and involvement,
43.8%, 53.6%, and 37.3% of NRs lacked confidence in distinguishing IBP from mechanical back pain, performing
musculoskeletal examination, and interpretation of plain radiography, respectively. Expensive biologic agents (31.2%) and
advanced disease stage at diagnosis (27.1%) were the main problems reported by rheumatologists.
Conclusion : Problems in diagnosis and management of SpA patients among NRs in Thailand included lack of knowledge
and lack of associated clinical skills. Issues reported by rheumatologists centered on case management limitations. In order
to improve overall quality of care for SpA patients, focused strategies should be implemented for both NRs and rheumatologists
that consider the needs of patients, clinicians, and policy makers.
Keywords : Ankylosing spondylitis, Axial spondyloarthritis, Spondyloarthritis, Survey on inflammatory back pain
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