Patients with ankylosing spondylitis (AS) seen at the University of Pennsylvania were more frequently prescribed either biologic disease-modifying antirheumatic drugs (bDMARDs) and conventional synthetic DMARDs (csDMARDS) by rheumatologists, while primary care providers (PCPs) more often opted to prescribe opiate and nonopiate pain medications, according to an abstract presented at ACR Convergence 2021.

Alexis Ogdie, MD, from the Hospital of the University of Pennsylvania, Philadelphia, presented the abstract.

Dr Ogdie and colleagues performed a retrospective cohort study of 1271 patients who were diagnosed with AS between January 2017 and September 2020, as shown by the University of Pennsylvania Health System electronic medical record.

The mean age of the patients studied was 51 years and 55% were male. The most commonly seen comorbidities were hyperlipidemia, hypertension, anemia, and depression; almost 10% of patients had been diagnosed with uveitis before or at the same time as their AS diagnosis.

Almost half of patients (49%) were seen by both a rheumatologist and PCP at or after their AS diagnosis; 42% were treated by a PCP only. Of patients followed by a rheumatologist, more than one-third (36%) were prescribed a bDMARD; however, only 9% of patients followed by a PCP received a prescription for a bDMARD.

Just under half of patients followed by a PCP only were prescribed an opiate (49%) or nonopiate (47%) pain medication. Rheumatologists prescribed opiate pain relief therapies to 16% of their patients and nonopiate pain medication to 20% of patients. Among patients seen by a rheumatologist only, 13% received csDMARD therapy, while 5% of patients followed by a PCP only were prescribed csDMARDs.

Of those patients followed by a PCP only, 43% were prescribed opiates, 41% were prescribed nonopiate pain medication, and 28% received nonsteroidal anti-inflammatory drugs (NSAIDs) during the first year after being diagnosed with AS. Among those patients who saw both a rheumatologist and PCP, 31% received bDMARDs, 27% were treated with NSAIDs, and 27% were most commonly prescribed nonopiate pain medications during the first year.

“While recommendations for the treatment of... [AS] are largely aligned across various guidelines, there remains variability in the treatment,” the authors wrote. “Patients with inflammatory lower back pain, a key symptom of AS, often first visit and receive treatment from their... [PCP] as opposed to a specialist such as a rheumatologist, which may contribute to this treatment variability,” they added.

The authors concluded, “These findings demonstrate the variability in prescribing patterns between PCPs and rheumatologists and highlight areas for targeted education among nonspecialists.”

—Rebecca Mashaw

Reference:
Ogdie-Beatty A, Magrey M, Fitzsimmons R, et al. Treatment of ankylosing spondylitis by primary care physicians and rheumatologists in an academic health system: a retrospective study. Presented at: American College of Rheumatology Convergence 2021; November 5-9, 2021; virtual. Abstract 0139.