Reasons for Diagnostic Delays of Axial Spondyloarthritis

Abstract

Introduction: The probability of development of axial spondyloarthritis (axSpA) is estimated to be above 90% among patients with chronic back pain, presence of HLA B27 antigen and positive family history of ankylosing spondylitis (AS), psoriasis, reactive arthritis, inflammatory bowel disease or uveitis. The nonradiographic axSpA and ankylosing spondylitis diseases’ activity has a comparable impact on the patients’ quality of life and from the practical point of view the approach to treatment of each of them is the same. The aim: The attempt to identify the reasons of diagnostic delays of AS among patients hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin and to suggest the ways of improving the accuracy of diagnostic track among other healthcare providers than rheumatologists. Material and methods: We performed a retrospective analysis of the records of 82 patients’ with the established diagnosis of AS, hospitalized in the Rheumatology and Connective Tissue Diseases Department in Lublin in 2000-2019, and of 45 years of age and older. Results: From among 82 patients (28 women and 54 men) the diagnosis of AS after 45 years of age was established in 25 patients (10 women and 15 men) – group t, and in the other 57 patients (group n) the diagnosis was established before 45 years of age. On average the age at the time of diagnosis in the whole group (t+n) was 40,7±10,2 (18-76) years, the age at the beginning of inflammatory back pain (age of axial symptoms) was 30,9±8,5 (13-51) years and the diagnostic delay (period between first axial symptoms and diagnosis establishment) was 9,75±9,5 (0-46) years. We did not find any statistically significant associations between sex and age at the moment of diagnosis, age of the beginning of axial symptoms and the time of diagnostic delay. There was no significant difference of incidence of enthesitis, uveitis, arthritis, prevalence of family history of spondyloarthritis and CRP level between group t and n. Antigen HLA B27 was more frequently present in group t. Conclusions: Instead of the recognition progress and worldwide popularization of knowledge about axSpA, the diagnostic delays in this field are still estimated to last many years, the patients are looking for other specialists’ help, and they can be not knowledgeable of the inflammatory back pain criteria. Currently, HLA B27 antigen and C-reactive protein are the two most commonly used biomarkers for diagnostic and disease activity monitoring purposes of axSpA and magnetic resonance is the only “imaging biomarker” The presence of extra-axial symptoms does not improve the diagnostic sensitivity.

Leczenie spondyloartropatii osiowych ze szczególnym uwzględnieniem postaci nieradiograficznej — rola sekukinumabu

“…Czas między wystąpieniem pierwszych objawów choroby a jej rozpoznaniem to średnio kilka, a nawet kilkanaście lat. Przyczyn tego zjawiska jest kilka, a wśród nich bardzo istotny jest fakt zbyt późnego kierowania pacjenta do specjalisty reumatologa (pacjenci są leczeni w poradni lekarza rodzinnego, poradni neurologicznej czy ortopedycznej), a problem ten obserwowany jest nie tylko w Polsce, ale na całym świecie [7,8].…”

Early Spondyloarthritis Clinic: Organizational Improvements in the Patient Journey

“…Diagnostic delay in SpA identification represents the main concern related with these diseases, as it may raise direct and indirect costs, it impacts the prognosis and undermines the therapeutic potential ( 4 – 6 ). In SpA as well as in all rheumatic diseases there is a “window of therapeutic opportunity,” namely a time period that runs from the onset of the first symptoms to the moment where the structural, irreversible damage begins ( 4 , 5 , 7 ). During this timeframe, any drug has a chance of success greater than if it is administered later.…”

“…During this timeframe, any drug has a chance of success greater than if it is administered later. The greatest diagnostic delay is observed in the Axial SpA, where patients wait even 10 years on average from the onset of the disease to diagnosis and therapy ( 4 , 6 , 7 ).…”

“…A factor contributing to late identification of these diseases is the lack of specific biomarkers, which could help in early diagnosis. In addition, referral is more complex in SpA than in other rheumatic diseases such as Rheumatoid Arthritis as it requires a multichannel approach (i.e., the involvement of several specialists) ( 7 – 9 ). The above issues reflect some of the main unmet needs of SpA diseases, which the Early SpA Clinic, a project providing an organizational model, useful for improving the performance of the healthcare facility tried to face and solve.…”

Biologic use in psoriatic arthritis and ankylosing spondylitis patients: a descriptive epidemiological study using linked, routine data in Wales, UK

“…PsA and AS are chronic inflammatory arthritic conditions associated with significant morbidity and poorer quality of life. The diagnosis of these conditions is often delayed [ 1 , 2 ] and this continues to be an issue in the UK [ 3 ].…”