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Abstract：
Introduction Non-radiographic axial spondyloarthritis (nr-axSpA) is within the spectrum of axial spondyloarthritis (axSpA). The emergence of the nr-axSpA concept, defined by the absence of significant erosive damage to the sacroiliac joints, has prompted numerous initiatives aimed at enhancing the early detection and management of this condition. The aim of the study was to assess the knowledge, attitudes, and practices related to the diagnosis and management of nr-axSpA by rheumatologists in Morocco. Methods We conducted a cross-sectional online survey among the rheumatologist community in Morocco. Rheumatologists received via e-mail a structured Google Forms (Google Inc., Mountainview, CA) questionnaire divided into four sections: sociodemographic data of rheumatologists, knowledge, attitudes, and practices related to the diagnosis and treatment management of nr-axSpA. Results A total of 110 rheumatologists (mean age of 44±13 years, 77.3% females, median professional experience of 12 years (4, 75; 26.25 years)) participated in the survey (response rate of 25%). Most responders reported a diagnosis delay issue in spondyloarthritis (SpA) (93.6%); 70.9% of rheumatologists incorrectly regarded the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA as diagnostic criteria. Rheumatologists\' awareness of recommended magnetic resonance imaging (MRI) sequences for detecting sacroiliac joint inflammation and structural changes in SpA varied significantly, from 69.1% to 14.5%. Their knowledge of additional subchondral edema cases in these joints, beyond SpA, ranged from 48.2% to 87.3%. Almost all rheumatologists believed that the use of sacroiliac MRI would contribute to the early diagnosis of axSpA (97.3%) but could also lead to false positive diagnoses, according to 47.3% of rheumatologists; 73.6% believed that incorrectly using the 2009 ASAS classification criteria as diagnostic criteria in nr-axSpA could also result in false-positive diagnoses. In their practice, 2009 ASAS classification criteria were used as diagnostic criteria in axSpA by 39.1% of rheumatologists. Of the total participants, 91.8% indicated that they approach nr-axSpA similarly to radiographic axial spondyloarthritis, with disparities in recommendations of biological therapies. Conclusion Our survey provides insight into the current status of nr-axSpA management among Moroccan rheumatologists. It also addresses concerns regarding the risk of false positive diagnoses when using the 2009 ASAS classification criteria for axSpA as diagnostic criteria by rheumatologists and the potential risk of misdiagnosis associated with excessive reliance on MRI, despite its utility for early diagnosis.
摘要：
非放射学轴性脊柱关节炎（nr-axSpA）属于轴性脊柱关节炎（axSpA）的范围。nr-axSpA概念的出现，定义为骶髂关节没有明显的侵蚀性损伤，促进了许多旨在加强对这种情况的早期发现和管理的举措。这项研究的目的是评估知识，态度，以及摩洛哥风湿病学家对nr-axSpA的诊断和管理相关实践。方法我们在摩洛哥风湿病学家社区中进行了一项横断面在线调查。风湿病学家通过电子邮件收到结构化的谷歌表格(谷歌公司，山景,CA)问卷分为四个部分：风湿病学家的社会人口统计数据，知识,态度，与nr-axSpA诊断和治疗管理相关的实践。结果共有110名风湿病专家(平均年龄44±13岁,77.3%女性，中位专业经验为12年(4,75;26.25年))参与调查(应答率为25%).大多数响应者报告脊柱关节炎（SpA）的诊断延迟问题（93.6％）；70.9％的风湿病学家错误地将2009年国际关节炎协会（ASAS）axSpA的分类标准视为诊断标准。风湿病学家对推荐的磁共振成像（MRI）序列检测骶髂关节炎症和SpA结构变化的认识差异很大，从69.1%到14.5%。他们对这些关节中其他软骨下水肿病例的了解，超越SpA,从48.2%到87.3%不等。几乎所有风湿病学家都认为使用骶髂MRI有助于axSpA的早期诊断（97.3%），但也可能导致假阳性诊断，47.3%的风湿病学家认为,在nr-axSpA中错误地使用2009年ASAS分类标准作为诊断标准也可能导致假阳性诊断.在他们的实践中,2009年ASAS分类标准被39.1%的风湿病学家用作axSpA的诊断标准。在所有参与者中，91.8%表明他们接近nr-axSpA类似于放射学的轴向脊柱关节炎，在生物疗法的建议方面存在差异。结论我们的调查提供了摩洛哥风湿病学家nr-axSpA管理现状的见解。它还解决了风湿病学家使用axSpA的2009ASAS分类标准作为诊断标准时对假阳性诊断的风险以及过度依赖MRI相关的潜在误诊风险的担忧。尽管它对早期诊断有用。
