Background The diagnosis of axial spondyloarthrits (AxSpA) is usually reported to be made with a mean delay of eight to eleven years. However in a recent nationwide Danish study, the mean diagnostic delay declined steadily from 5.5 years (year 2000) to 3-4 months (year 2011) .
Objectives To quantify the diagnostic delay in patients with AxSpA in France, to explore factors associated with this diagnostic delay, and to explore in a subgroup of patients the procedures and investigations performed in the time between symptom onset and diagnosis.
Methods Two cross-sectional observational studies were performed, one in 2008 in one tertiary referral center and one in 2013 in 3 centers in Paris, France. A random sample of patients with AxSpA (according to both ASAS criteria and rheumatologist expert opinion) filledin self-reported data and their medical files were searched. Diagnostic delay was analyzed as the time interval from the date of first symptoms to the date of diagnosis (self reported and in the medical file). Potential predictive factors of diagnostic delay analyzed by multiple linear regression were demographic factors, HLA B27 status, year of diagnosis, clinical presentation and sacro iliitis on MRI or radiography. In a subset of patients, investigations performed in the time between symptom onset and diagnosis were collected from the patient and the medical file.
Results In all, 432 patients were analyzed: the mean age at diagnosis was 34.4 (standard deviation 12.6) years, the mean age at first symptoms was 29.2 (12.2) years, the mean disease duration at the time of the present assessment was 13. 7 (10.6) years, 56.2% were males. In all, 66.7% were HLAB27 positive, and 70.2% had radiographic sacro iliitis according to local reading of X Rays. The mean diagnostic delay was 5.2 (6.9) years, with a median of 2.0 years (IQR, 1-7; range: 0-43). By multivariate analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta=0.164; p<0.0001), more frequent family history of AxSpA (beta=2.04; p=0.003), less frequent peripheral arthritis or dactylitis (beta=-1.71 p=0.01), and more frequent enthesitis (beta=1.70; p=0.01). In a subset of 167 patients, investigations before diagnosis were explored: patients had seen a mean of 2.8 (2.0) physicians; 22.6% of patients had spine or joint injections, 11.3% had other invasive investigations such as synovial biopsy or arthroscopy, 13,2% were treated with oral corticosteroids and 1,9% had spine surgery performed before diagnosis.
Conclusions In this study, the median diagnostic delay in AxSpA was around 2 years, but for some patients it was much longer. A more “typical” SpA clinical presentation, in particular without enthesitis, was associated with a shorter diagnostic delay, whereas B27 positivity and sacroiliitis were not associated with this delay. This study indicates diagnostic delay may be for most patients shorter than previously reported. However, some patients had very long diagnostic delays and for some of them this lead to unnecessary or dangerous diagnostic or therapeutic procedures.
Sorensen J. et al, Ann. Rheum. 2014
Disclosure of Interest None declared