In a recent article published in the journal Rheumatology, Imke Redeker and colleagues in Germany report that even with recent advances in diagnosing axial spondyloarthritis (axSpA), diagnostic delays are still too long.
Axial spondyloarthritis is a term that encompasses both ankylosing spondylitis and nonradiographic axial spondyloarthritis—which is essentially early stage ankylosing spondylitis before structural damage, such as sacroiliitis or spinal syndesmophyte, is visible radiographicly.
Delays in diagnosing axSpA can be as long as five to 10 years after onset. The authors write that early diagnosis of axSpA is crucial for initiation of optimal treatment.
The Assessment of SpondyloArthritis International Society (ASAS) diagnostic criteria suggest that physicians rely less on plain radiographic changes to identify changes in bone to make a diagnosis. Magnetic resonance imaging of the sacroiliac joint may lead to an earlier diagnosis and treatment.
The authors of the report sought to determine the extent of diagnostic delays in axSpA.
Data for this study were obtained from the Linking Patient-Reported Outcomes with CLAIms data for health services research in Rheumatology (PROCLAIR) network. PROCLAIR is a randomized sample of patients in Germany with asSpA. All subjects received questionnaires where they relayed the date of SPA-related symptom onset and the date of diagnosis.
Both univariate and multivariate analyses were performed looking at age at symptom onset; HLA-B27 status; presence of psoriasis, uveitis or inflammatory bowel disease as well as educational level.
2,082 respondents consented to participate with 1,776 confirming the date of symptom onset and 1,677 further supplying the date of axSpA diagnosis as well. Ultimately, this cohort of 1,677 respondents was included in the final analysis.
Younger women with psoriasis who did not carry the HLA-B27 gene were more likely to experience the longest diagnostic delay of more than five years. In addition, patients with higher educational levels were often diagnosed later than those with lower educational levels.
Diagnostic delay was not significantly different between patients diagnosed between 1996 and 2001 and those diagnosed between 2006 and 2015 uncovering a lack of improvement over time. Multivariate analysis confirmed the relationship between young age, psoriasis, female gender, and lack of HLA-B27 genotype with longer diagnostic delays in axSpA.
See the next page for an analysis by Dr. Weiss.