Objectives: To explore the patients' journey and evaluate the humanistic and economic burden of axial spondyloarthritis (axSpA) in Greece.

Methods: A cross-sectional online survey was conducted among axSpA patients in Greece, members of the "Reumazin" association. Data were collected using structured questionnaires covering sociodemographic characteristics, medical history, patient experience, health-related quality of life (HRQoL) using the Ankylosing Spondylitis Quality of Life (ASQoL) questionnaire, and work productivity using the Work Productivity and Activity Impairment (WPAI) questionnaire. Additionally, data on treatment, healthcare utilization, and economic burden over the past year were collected.

Results: The survey included 150 axSpA patients. The median (Q1–Q3) time from symptom onset to axSpA diagnosis was 14.8 (8.0 – 29.5) months. Common initial symptoms were back pain (77%) and stiffness (51%). Orthopedists were the first consulted specialists for 53% of patients. Misdiagnosis was reported in 63% of patients, with sciatica being the most common incorrect diagnosis (30%). The median (Q1–Q3) time from axSpA diagnosis to treatment initiation was 1.5 (1.0 – 3.0) months. Conventional DMARDs were the most common first treatment (23%). Regarding HRQoL, the median (Q1–Q3) ASQoL score was 8.0 (5.0 – 12.0). The mean (95% CI) annual direct healthcare (outpatient visits, hospitalizations, treatment) cost for each patient was €399.9 (€353.5 – €453.3). Indirect costs due to work productivity loss were notable, resulting in a mean annual total cost per patient of €3,800.5 (€3,033.1 – €4,930.3). Hospitalization occurred in 6% of patients, with a median (Q1–Q3) duration of 5 (4 – 10) days.

Conclusions: Our results highlight significant delays in diagnosis and high rates of axSpA misdiagnosis in Greece. Although a median diagnostic delay of 14.8 months is shorter than what is reported for other European countries, the condition's impact on HRQoL and the economic burden remains considerable. These findings underscore the need for improved diagnostic and management practices.