1Muhammad Saleem, 1Nanik Ram, 1Sajjad Ali Khan, 1Zafar Aleem Suchal

1Aga Khan University Hospital, Karachi, Pakistan


There are many challenges in the referral, diagnosis, and management of patients with suspected (AxSpA) worldwide. Gulf-REDMAS comprises a group of expert rheumatologists from the Gulf countries who convened to create and disseminate a survey to understand the aforementioned challenges with the main aim to fill the evidence gap

Material(s) and Method(s):

An anonymous online survey consisting of 35 multiple choice closed questions that lasted for 1 month was circulated among practicing rheumatologists in the Gulf countries (calculated sample size was 101).


132 rheumatologists completed the survey from 371 rheumatologists in the region.

The majority of responders (88%) noted that they faced delays in the referral of AxSpA patients to their clinic, with the main reason being a ‘lack of disease awareness by primary care physicians’ (56%) (Table).  The survey respondents surmised that the leading reasons for non-rheumatology specialists’ reluctance to refer patients with suspected AxSpA included ‘lack of awareness of long-term complications of spondyloarthritis’ (34%), and ‘some non-rheumatology specialists think they can treat and diagnose AxSpA without the need to refer to a rheumatologist’ (28%).

Two-thirds of survey respondents (66%) highlighted that the greatest challenge being ‘patients who present with atypical symptoms e.g., with <3 months back pain, chronic back pain occurring >45 years of age, or chronic back pain with ≥1 spondyloarthritis features but without sacroiliitis on imaging’ (51% of responders who highlighted they faced a challenge).

The main patient-related challenges to management of axial spondyloarthritis were: ‘patients cannot access the medication as it is unavailable in my hospital/clinic pharmacy’ (31%, first reason) and ‘patients may have fears of drug side effects (39.6%, second reason).


Our study showed that SGLT-2 inhibitor can be reliably used in paResponses to this survey highlighted several challenges in the referral, diagnosis, and management of AxSpA patients. Future recommendations that should be implemented to address these challenges.