By Brontë H. Lacsamana, Reporter

AXIAL spondyloarthritis (axSpA), a chronic illness characterized by frequent and persistent back pain that can render one immobile, must be diagnosed early in order to lessen its functional, psychosocial, and economic burden on Filipinos, according to the 2022 Philippine Map of Axial Spondyloarthritis (PMAS).  

The study surveyed 128 adult axSpA patients from July to October 2021 and found that Filipinos with axSpA are diagnosed, on average, 5.8 years after developing symptoms.

“With these new data, we hope to improve the quality of care, access to treatment, and eventually health outcomes for our patients with axSpA,” said Dr. Bernadette Heizel M. Reyes, PMAS principal investigator and University of the Philippines-Philippine General Hospital rheumatology professor, at the launch of the survey results.

Women with axSpA have a more significant delay in diagnosis, she said. The survey found that it takes 6.5 years for Filipina patients to be diagnosed due to the misconception that axSpA is a male-specific disease.

“For women, more common medical conditions are considered before a diagnosis of axSpA is made,” said Dr. Reyes.

Since it’s a chronic inflammatory disease that mainly affects the spine, symptoms manifest as debilitating back pain, stiffness, and fatigue of the pelvis and lower back. AxSpA occurs in about 1% of the global population.

Dr. Juan Javier Lichauco, president of the Philippine Rheumatology Association (PRA), said that awareness is key to shortening diagnostic delay of the disease.

Awareness campaigns include Got Ur Back by the Axial Spondylarthritis Association of the Philippines (ASAPh) and Novartis’ mobile app Clarrio that supports patients with axSpA.

Conducted by the PRA and ASAPh, the PMAS survey is the first comprehensive study of patients with axSpA in the Philippines, following the footsteps of the International Map of Axial Spondyloarthritis (IMAS) that was done a year prior.

The Filipino respondents, aged between 18 and 77 years, are mostly male (76.6%). Three in four complain of spinal stiffness, which leads to much difficulty doing routine daily tasks like tying shoelaces.

As for comorbidities, 44.3% are overweight or obese, 35.6% have hypertension, 33.6% have uveitis or eye inflammation, and 28.2% have high cholesterol.

“Knowing the comorbidities is important. For example, with uveitis that affects the eyes — even if the symptoms are just slight, we doctors must work hard to investigate this,” Dr. Reyes said.

Many respondents also reported issues related to mental health that affected their productivity, namely sleep problems (28%), anxiety (25.9%) and depression (25%).

“AxSpA usually affects young adults who are at the early stages of their professional career. The activities that we once enjoyed doing can no longer be done. We often lose our jobs or our options are limited because of our decreased mobility,” said ASAPh president Clark B. Ferrer, an engineer who has had the disease for 21 years.

Mr. Ferrer also pointed out the need for more rheumatologists around the country.

“The lack of access to rheumatologists and treatments, especially outside of the National Capital Region, really affects our finances,” he said.

Access must be improved, Dr. Reyes agreed, citing PMAS data that showed 75.8% of respondents were diagnosed by rheumatologists while the rest were diagnosed by orthopedic specialists. Before diagnosis, multiple consultations had to be done.

Nearly half of the survey respondents were from the National Capital Region and nearby regions (45.4%), with the rest hailing from elsewhere.

PRA’s Dr. Lichauco said: “There are only 240 rheumatologists in the entire country. We clearly need to train more.”

This goes for general practitioners as well, since the survey revealed that patients also consulted them many times for diagnosis and/or treatment along with rheumatologists.

“We can still do better by educating and collaborating with primary care physicians and specialists to further shorten the time to diagnosis. In addition, the PMAS study can enhance the patient-physician relationship,” he said.

Specialists to further involve in axSpA include ophthalmologists, gastroenterologists, and rehabilitation specialists, as they all address comorbidities.