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

Yi, Esther; Ahuja, Amit; Rajput, Tanvi; George, Aneesh Thomas; Park, Yujin

doi:10.1007/s40744-020-00194-8

Cited by 82 publications

(85 citation statements)

References 80 publications

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“…This artefact disappears in fixed-effects models, which were not used in this study due to high heterogeneity between the studies. We did not review the impact of delay to diagnosis as this was recently reviewed by Yi et al [5].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Those with longer delays to diagnosis also report greater work disability, unemployment and healthcare costs [5]. Although the impact of delay is well described, potential causes of delay (i.e., how delay can be improved) are not.…”

Section: Introductionmentioning

confidence: 99%

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Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Zhao¹,

Pittam²,

Harrison³

et al. 2020

Preprint

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Background . Delay to diagnosis in axial spondyloarthritis (axSpA) is longer than many other rheumatic diseases. Prolonged delay has been shown to associate with poorer outcomes including functional impairment and quality of life. Our aims were to describe 1) global variation in delay to diagnosis, 2) factors associated with delay, and 3) differences in diagnostic delay between axSpA and psoriatic arthritis (PsA).Methods . We searched Medline, PubMed, EMBASE and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Delay to diagnosis was defined as years between age at symptom onset and age at diagnosis. We pooled mean diagnostic delay using random-effects inverse variance meta-analysis. We examined variations in pooled estimates using pre-specified subgroup analyses and sources of heterogeneity using meta-regression.Results. A total of 54 studies reported mean diagnostic delay in axSpA patients. The pooled mean delay was 6.8 years (95% confidence interval 6.2 to 7.3) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delay than those from middle-income countries. Factors consistently reported to be associated with longer delay were: lower education levels, younger age at symptom onset and absence of extra-articular manifestations. Pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95%CI 1.6 to 3.6).Conclusion. For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world, although some countries have reported remarkable improvements. Patient factors (education) and disease presentation (age at onset and extra-articular manifestations) should inform awareness campaigns to improve delay. Targets for improvement should aim to resemble delays in other spondyloarthritis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Zhao¹,

Pittam²,

Harrison³

et al. 2020

Preprint

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show abstract

“…This artefact disappears in xed-effects models, which were not used in this study due to high heterogeneity between the studies. We did not review the impact of delay to diagnosis as this was recently reviewed by Yi et al [5]. Meta-regression examines relationships between summary data and should not be interpreted as traditional hypothesis testing of individual patient data.…”

Section: Discussionmentioning

confidence: 99%

“…There is abundant evidence that diagnostic delay is associated with worse functional impairment, greater radiographic progression, poorer quality of life and reduced response to treatment [5,6]. Those with longer delays to diagnosis also report greater work disability, unemployment and healthcare costs [5]. Although the impact of delay is well described, potential causes of delay (i.e., how delay can be improved) are not.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Zhao

Pittam

Harrison

et al. 2020

Preprint

View full text Add to dashboard Cite

Background. Delay to diagnosis in axial spondyloarthritis (axSpA) is longer than many other rheumatic diseases. Prolonged delay has been shown to associate with poorer outcomes including functional impairment and quality of life. Our aims were to describe 1) global variation in delay to diagnosis, 2) factors associated with delay, and 3) differences in diagnostic delay between axSpA and psoriatic arthritis (PsA).Methods. We searched Medline, PubMed, EMBASE and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Delay to diagnosis was defined as years between age at symptom onset and age at diagnosis. We pooled mean diagnostic delay using random-effects inverse variance meta-analysis. We examined variations in pooled estimates using pre-specified subgroup analyses and sources of heterogeneity using meta-regression.Results. A total of 64 studies reported mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% confidence interval 6.2 to 7.2) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delay than those from middle-income countries. Factors consistently reported to be associated with longer delay were: lower education levels, younger age at symptom onset and absence of extra-articular manifestations. Pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95%CI 1.6 to 3.6). Conclusion. For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world, although some countries have reported remarkable improvements. Patient factors (education) and disease presentation (age at onset and extra-articular manifestations) should inform awareness campaigns to improve delay. Targets for improvement should aim to resemble delays in other spondyloarthritis patients.

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Continuing Professional Development in Rheumatology for Primary Care Clinicians: A Systematic Review

Robbins

Maciuba

Maggio

et al. 2022

Arthritis Care & Research

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Objective. To determine the quality of published rheumatology-focused continuing professional development (CPD) for primary care clinicians (PCCs) for improving the care of patients with rheumatic diseases.Methods. The authors conducted a systematic review of CPD focused on rheumatology topics for PCCs. A librarian systematically searched PubMed, Embase, Web of Science, ERIC, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Sinico. Studies were limited to those conducted in North America after 1993. An extraction form that included the Medical Education Research Study Quality Instrument and the Kirkpatrick levels of learning outcomes was created through an iterative process and applied to the included articles.Results. In total, 725 articles were retrieved, of which 9 were included. Results showed that CPD was directed more at noninflammatory arthritis than inflammatory arthritis. Autoimmune diseases were underrepresented; 4 studies discussed rheumatoid arthritis, and 1 study examined rheumatologic topics broadly. Newer research tended to include multimodal approaches that combined didactic and active learning strategies, showing an evolution toward more active learning. Although online learning is increasingly popular, interventions were predominantly face-to-face, with only a single example of e-learning. Studies were predominantly of moderate quality.Conclusion. Published studies of rheumatology-focused CPD are moving toward more interactive teaching modalities and are typically conducted in person, although virtual options for rheumatology-focused CPD should be explored to improve access to CPD. Autoimmune disease is an uncommon topic in CPD and represents an area for future expansion. Efficacy was difficult to assess given that most of the studies assessed for learner satisfaction, knowledge acquisition, or behavior change, whereas only 1 study focused on patient outcomes.

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

Cited by 82 publications

References 80 publications

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Continuing Professional Development in Rheumatology for Primary Care Clinicians: A Systematic Review

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