ABS0421 UNRAVELLING EARLY AXIAL SPONDYLOARTHRITIS: DISTINCT CLINICAL AND DEMOGRAPHIC PROFILES OF EARLY VERSUS LATE DISEASE

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Background: Early recognition of axial spondyloarthritis (axSpA) is critical for improving outcomes. Emerging evidence suggests distinct differences between patients presenting with early axSpA (≤2 years symptom duration) and those with late axSpA (>2 years symptom duration), emphasizing the importance of tailored management strategies. Objectives: To characterise the demographic, clinical, and management profiles of patients with early axSpA compared to those with late axSpA and assess statistically significant differences in key features. Methods: This retrospective cohort study analysed data from 366 patients with axSpA followed between 2018 and 2023. Patients were categorized into early (≤2 years symptom duration) and late (>2 years) groups at the time of diagnosis. Variables including demographics, clinical measures, and disease management practices were analysed. Statistical comparisons were performed using t-tests for continuous variables, with significance set at p < 0.05. Results: Among the 366 patients, 259 (70.8%) were male and 107 (29.2%) were female. The mean age at diagnosis was 35.8 years (SD: 10.0 years). HLA-B27 positivity was observed in 328 patients (89.6%). Mean age was slightly higher in the early group (36.9 ± 9.6 years) compared to the late group (35.6 ± 10.1 years), though not statistically significant (p = 0.352). A higher proportion of females were observed in the early group (62.2% vs. 45.2%; p=0.017), Figure 1. Non-radiographic axSpA (nr-axSpA) was more prevalent in the early group (66.7% vs. 13.2% in the late group). Time from symptom onset to GP visit was shorter in early axSpA (mean 1.5 vs. 5.3 years; p < 0.001). GP referral to diagnosis was faster in early axSpA (mean 0.8 vs. 3.1 years; p < 0.001). There was higher HLA-B27 positivity in early axSpA (80.0% vs. 70.0%; p=0.048), lower mean ESR (12.3 mm/hr vs. 20.1 mm/hr; p=0.012) and CRP (6.8 mg/L vs. 15.2 mg/L; p < 0.001). There were less frequent extra-musculoskeletal manifestations, EMMs (22.5% vs. 37.8%; p=0.034) in the early group. Psoriasis (PsO) was less common in the early group (1.6% vs. 8.6%; p=0.095). Crohn's disease was more frequent in the late group (4.6% vs. 1.6%; p > 0.05). No significant differences were found in physical therapy or chiropractic care before diagnosis (p > 0.05). Referral pathways were GP-dominated, with no group differences. Conclusion: The findings of this study show a higher prevalence of females and non-radiographic axSpA in the early group. This aligns with other studies [1] which showed a higher prevalence of nr-axSpA in females. There was higher HLA-B27 positivity and lower inflammatory markers in early axSpA reflecting milder systemic inflammation. The mean age was slightly higher in the early group which is in keeping with later onset of symptoms in the nr-axSpA compared to radiographic axSpA [2]. This aligns with studies indicating that early-stage axSpA is more likely to present with non-radiographic features, emphasizing the importance of early detection and intervention in preventing progression to radiographic disease. The less frequent PsO and Crohn's disease in early axSpA align with literature suggesting that extra-articular manifestations often develop later. These insights reinforce tailored strategies for early disease recognition and management. Furthermore, the shorter diagnostic delays observed in this study highlight the importance of improving diagnostic pathways, especially in younger and female patients, to optimise outcomes. This study highlights distinct demographic and clinical features in early axSpA compared to late axSpA. Reduced diagnostic delays, lower inflammatory markers, differences in sex and extra-musculoskeletal manifestations underscore the critical need for awareness and tailored intervention in early axSpA. These findings underscore the importance of proactive management strategies to mitigate disease progression and enhance quality of life in axSpA. REFERENCES: [1] Lorenzin M, et al. Relationship Between Sex and Clinical and Imaging Features of Early Axial Spondyloarthritis: Results From a 48 Month Follow-Up (Italian Arm of the SPACE Study). Scand J Rheumatol. 2023;52(5):519-529. doi:10.1080/03009742.2023.2169990. [2] Londono J, Pacheco-Tena C, Santos AM, et al. Scientific Reports. 2024;14(1):10342. doi:10.1038/s41598-024-61001-w. Figure 1Demographics, clinical and laboratory features in early vs late axial spondyloarthritis. ESR in mm/hr. CRP in mg/L. Acknowledgements: NIL . Disclosure of Interests: Antoni Chan Speakers bureau for Novartis, UCB, Lilly, Abbvie, Amgen, Kathryn Rigler: None declared. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.

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