Factors Associated With Diagnostic Delay of Axial Spondyloarthritis in Colombian Patients

Abstract

Background/ObjectiveThe diagnostic delay of axial spondyloarthritis (axSpA) is globally reported to be between 3 and 11 years. Early diagnosis and treatment have long-term benefits for patients and the health care system. Several international studies have evaluated some factors associated with diagnostic delay, but there are no known studies in the Colombian population. This study assesses the factors associated with diagnostic delay of axSpA in a rheumatology center in Bogota, Colombia.MethodsThis monocentric analytical cross-sectional study was done in a specialized rheumatology center. Patients who fulfilled the 2009 Assessment of Spondyloarthritis International Society (ASAS) classification criteria for axSpA were included. Information was obtained from medical records and a phone call. Bivariate and multivariate analyses were done to assess the associated factors with diagnostic delay.ResultsOne hundred one patients were included, 54 were women (53.5%). The median diagnostic delay was 2 years (interquartile range, 1–7). The bivariate analysis showed that a younger age at diagnosis (p = 0.042) and previous diagnosis of lumbar degenerative disease (p = 0.029) were associated with a longer diagnostic delay. The logistical regression showed that previous lumbar degenerative disc disease (odds ratio, 2.8; 95% confidence interval, 1.09–7.53) and fibromyalgia (odds ratio, 4.0; 95% confidence interval, 1.2–13.1) diagnosis were both associated with a longer diagnostic delay.ConclusionsFactors associated with a longer diagnostic delay were previous diagnosis of lumbar degenerative disc disease and fibromyalgia. Additional studies are needed so that the reasons for diagnostic delay are understood and early diagnosis and management of axSpA are enabled.

Diagnostic uncertainty and axial spondyloarthropathy: A case for cognitive debiasing through practice‐based learning and improvement activity

“…Premature closure of clinical reasoning may ensue from resultant unconscious ignorance, leading to diagnostic error (Han et al., 2011). The identification of lumbar disc‐pathology via MRI as a risk factor for AxSpA diagnostic delay, perhaps serves as an example of this phenomenon (Parada‐Arias et al, 2022). Clinicians' may be subject to confirmation bias in pursuing causes of low back pain perceived to be more common than AxSpA.…”

Screening Tools for Spondyloarthritis in Patients With Psoriasis, Uveitis, and Inflammatory Bowel Disease: A Scoping Review

“…The diagnosis of SpA, particularly AxSpA, is frequently delayed by several years. [2][3][4][5][6] Multiple factors may contribute to this delay, including insidious onset, intermittent disease course, lack of awareness among nonrheumatology health care providers, absence of specific diagnostic biomarkers, and confusion with other musculoskeletal disorders. 4,[7][8][9] A diagnostic delay of as little as six months from symptom onset is associated with structural damage and poor functional outcomes.…”

“…[2][3][4][5][6] Multiple factors may contribute to this delay, including insidious onset, intermittent disease course, lack of awareness among nonrheumatology health care providers, absence of specific diagnostic biomarkers, and confusion with other musculoskeletal disorders. 4,[7][8][9] A diagnostic delay of as little as six months from symptom onset is associated with structural damage and poor functional outcomes. [10][11][12] Therefore, early diagnosis and initiation of therapy are critical to prevent disability; this is particularly important considering the widespread availability of therapeutic agents that can delay or halt disease progression.…”

Validation of the Fibromyalgia Rapid Screening Tool in patients with axial spondyloarthritis: Polish version adaptation and value in clinical practice

“…Compared to patients without FM, patients with FM have significantly higher disease activity, worse physical functioning, and lower quality of life as measured by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), BASFI (Bath Ankylosing Spondylitis Functional Index), and ASQoL (Ankylosing Spondylitis Quality of Life), respectively [1,3]. The diagnosis of FM also increases the risk (odds ratio 4, 95% CI 95% 1.2-13.1) of the diagnostic delay of axSpA [4]. The influence of FM on the response to treatment (including biologics) remains unclear -studies show both a worse response in axSpA patients with FM vs without FM [5,6] and a comparable one [7].…”