Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis

Abstract

Objective.To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases.Methods.A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model.Results.The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4–10.1) for women and 6.5 (5.6–7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31–0.89), indicating that men were diagnosed 0.6 year (7 months) before women.Conclusion.Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.

The European Map of Axial Spondyloarthritis: Capturing the Patient Perspective—an Analysis of 2846 Patients Across 13 Countries

“…First, there is an ongoing and critical need for early and accurate diagnosis. The EMAS diagnostic delay was calculated at over 7 years and confirmed the results of a meta-analysis conducted by Jovaní et al, which found the diagnostic delay to be 8.8 years for females and 6.5 years for males [16]. Furthermore, EMAS results showed that patients on average visited two healthcare professionals, mainly general practitioners (GPs), followed by orthopedic specialists, physiotherapists, and osteopaths (excluding rheumatologists), prior to receiving a diagnosis.…”

Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review

“…Because most of the studies included in this review were conducted across Europe and Asia, results may not be representative of all patients or healthcare systems. The majority of the studies included primarily male patients and therefore did not capture the longer delays typically experienced by female patients or account for other sex differences [86][87][88][89][90][91][92]. Additionally, the outcome measures used to assess economic and humanistic burden varied among the included studies.…”

Comparative Analysis of Main Clinical Manifestations in Males and Females With Early Axial Spondyloarthritis

“…При одинаковой длительности болезни среди мужчин было больше пациентов с АС, чем среди женщин. Согласно зарубежным данным, период от появления первых симптомов до установления диагноза АС у мужчин короче, чем у женщин, в среднем на 2 года [13]. Различия могут быть обусловлены более быстрым прогрессированием структурных изменений в аксиальном скелете у мужчин с АС [7].…”

“…В конце прошлого века на правильную постановку диагноза у мужчин уходило от 5 до 7 лет, в то время как у женщин -от 9 до 14 лет [12]. Согласно последнему метаанализу, в который вошли 42 исследования (23 889 пациентов с аксСпА, 32,3% из них -женского пола), у женщин диагностика заболевания достоверно запаздывала в среднем на 2,3 года по сравнению с противоположным полом [13]. Такая разница во времени установления диагноза у женщин может объясняться как меньшей частотой воспалительной боли в нижней части спины, являющейся одним из характерных признаков аксСпА, так и преимущественным поражением шейного и грудного отделов позвоночника в дебюте заболевания [14].…”