University Hospitals First in Nation to Employ Tech-Based Solution to Improve Detection of Under-diagnosed Form of Arthritis

UH Clinical Update | February 2025

University Hospitals is the first center in the U.S. to implement a global project to improve detection and care for axial spondyloarthritis (axSpA) – a paradoxical and often-undiagnosed type of arthritis caused by chronic inflammation.

The condition causes pain and swelling in the spine and the sacroiliac joints, where the spine and pelvis connect. Patients develop bone loss, and, at the same time, they develop bone spurs or growths called syndesmophytes in the spine. This causes the bones in the spine to start fusing.

Marina Magrey, MD

The global initiative, dubbed FASTRAX and funded by the global biopharmaceutical company UCB, aims to cut the time to axSpA diagnosis in half, says UH project leader Marina Magrey, MD, Chief of Rheumatology at UH Cleveland Medical Center and Director of the Spondyloarthritis Center. This, in turn, will put patients in line to get appropriate treatment earlier, staving off poor outcomes like spinal fusion. On average, it takes an axSpA patient eight to nine years from the onset of symptoms to receive a correct diagnosis, she says. Even then, she says, the diagnosis is a difficult one – even for a rheumatologist.

“Early diagnosis is so important,” Dr. Magrey says. “With the current delay, a patient’s back fuses and then it’s irreversible.”

FASTRAX in Action

To implement FASTRAX at UH, Dr. Magrey and the IT team are leveraging our new capabilities in Epic.

“This program utilizes a proactive approach to identify patients at risk for axSpA,” Dr. Magrey says.

Here's how it works:

1. Patient Identification: EPIC identifies patients who may be at risk for axSpA based on specific criteria, such as seeing a primary care provider three times in 18 months for chronic back pain. Patients flagged in this way must also be under age 50.
2. Questionnaire: Identified patients automatically receive a brief questionnaire based on Assessment of SpondyloArthritis International Society (ASAS) questionnaire via MyChart. This validated tool helps assess for symptoms associated with axSpA.
3. Automated Scheduling: Patients who answer "yes" to four or more questions on the questionnaire are scheduled for an appointment with a UH rheumatologist.
4. Primary Care Provider Notification: Rheumatology schedulers notify primary care providers via an In-Basket message when their patient has been flagged by the system and scheduled for an appointment based on their ASAS questionnaire responses.

“This notification is for informational purposes only and does not require action by the primary care providers, except maybe a referral if the patient’s insurance requires, Dr. Magrey says. “There's a big delay in diagnosing these patients, but we wanted to see how we could do it without burdening our primary care doctors.”

In the six-month FASTRAX pilot phase, four primary care practices within UH are receiving these notifications, with more to come if the program proves successful.

Dr. Magrey says she believes FASTRAX’s mix of technology and simplicity is what’s needed to help solve the problem of delayed axSpA diagnosis.

“We wanted something very simple,” she says. “We get a good bang for our buck without asking too many questions. We didn't want to burden and fatigue the patient. Instead, we wanted something where we could get to the information we need to try to make a difference.”

She says she’s hopeful about the impact the project will have.

“We believe this program will significantly benefit our patients,” she says. “It will promote early detection, leading to earlier diagnosis and treatment of axSpA, while improving patient outcomes: Early intervention can help prevent disease progression and improve quality of life. We are confident that this pilot program will be a valuable tool in enhancing the care we provide to our patients.”

For more information on this project, please email Marina.Magrey@UHhospsitals.org.