Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis

Abstract

Background Delay to diagnosis in axial SpA (axSpA) is longer than in many other rheumatic diseases. Prolonged delay is associate with poorer outcomes, including functional impairment and quality of life. Our aims were to describe global variation in delay to diagnosis, factors associated with delay, and delay compared with PsA. Methods We searched MEDLINE, PubMed, Embase and Web of Science using a predefined protocol. Diagnostic delay was defined as years between the age at symptom onset and at diagnosis. We pooled the mean delay using random effects inverse variance meta-analysis. We examined variations in pooled estimates using prespecified subgroup analyses and sources of heterogeneity using meta-regression. Results A total of 64 studies reported the mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% CI 6.2, 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 delays than those from middle-income countries. Factors consistently reported to be associated with longer delays were lower education levels, younger age at symptom onset and absence of extra-articular manifestations (EAMs). The pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95% CI 1.6, 3.6). Conclusion For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world. Patient factors (e.g. education) and disease presentation (onset age and EAMs) should inform campaigns to improve delay.

Depression and anxiety symptoms at TNF inhibitor initiation are associated with impaired treatment response in axial spondyloarthritis

“…Symptom onset is commonly in early adulthood, which can be a critical time for education, career and relationships. The consequence of these disruptive symptoms on mental health is compounded by the often-significant delays to diagnosis and treatment [ 1 ]. The burden of mental health comorbidities is high, for example depression prevalence ranges from 15% to 38% depending on the screening tool and population [ 2 ].…”

Diagnostic delay is common for patients with axial spondyloarthritis: results from the National Early Inflammatory Arthritis Audit

“…Diagnostic delay is a significant problem in axSpA [ 1 , 2 ]. A meta-analysis of 64 studies in axSpA patients reported a pooled mean diagnostic delay of 6.7 years [ 3 ]. Delayed diagnosis in axSpA is associated with worse clinical, humanistic and economic outcomes [ 4 ], while treatment with TNF inhibitors improves clinical outcomes and radiographic progression more effectively when commenced earlier in the disease process [ 5 ].…”

Clinical Features and Prevalence of Spondyloarthritis in a Cohort of Italian Patients Presenting with Acute Nongranulomatous Anterior Uveitis

“…Anterior uveitis is the most common extra-articular manifestation of SpA and is characterized by nongranulomatous clinical features. A well-structured screening of patients affected by NGAU could allow early diagnosis, considering that the mean diagnostic delay of SpA from symptom onset ranges from 4.9 to 6.8 years [ 15 , 16 ]. It must be taken into account that delayed diagnosis is associated with worse spinal functional impairment, greater radiographic progression, reduced response to treatment, and poorer quality of life [ 17 , 18 ].…”