Background The diagnostic delay in axial spondyloarthritis is reported to be improving after campaigns by ASAS and the rheumatology community to educate primary care physicians to refer patients for early assessment1. MRI scanning has also been in widespread use since 2000. We conducted a local study to assess if diagnostic delay was improving in our well-defined cohort of ankylosing spondylitis (AS) patients who are reviewed in our physiotherapy-led service, and to compare this with national trends.
Objectives We set out to determine the time to diagnosis of AS in our cohort and to assess if this has changed over time. Our aim is to reduce diagnostic delay by educating local primary care clinicians about inflammatory back pain (IBP) and the importance of early recognition and referral.
Methods Patients were identified from the physiotherapy database of 53 patients currently reviewed under the AS service at a district hospital in the North West of England. We assessed mean and median delay to diagnosis, gender, family history of AS, those diagnosed pre- and post-2000, patient age and date of first presentation to primary care with IBP, and date of first rheumatology review. Only those fulfilling diagnostic criteria for AS were included in the dataset.
Results 44 males and 9 females with age range 28–83 years.
Mean delay to diagnosis was 8.94 years. Median delay to diagnosis: 8 years.
1962–1999 (10 patients) Mean 6.7 years. Median 7 years
2000–2004 (13 patients) Mean 9.5 years. Median 7 years
2005–2009 (15 patients) Mean 9.8 years. Median 8 years
2010–2015 (16 patients) Mean 9.1 years. Median 7 years
Range of diagnostic delay was 0 to 40 years. 15% were diagnosed in <2 years. 42% diagnosed in <5 years. 58% diagnosed in <10 years. The pre-2000 mean delay to diagnosis was 6.7 years, Post-2000 mean delay was 9.45. However, 81% of our AS patients were diagnosed post-2000.
42% of patients were on biologic therapy, the remainder were on NSAIDs. No significant difference was seen between the sexes. 19% of patients had a clear family history of AS, and no difference was seen in delay to diagnosis compared to those without family history.
Conclusions Our findings closely reflect those of national data obtained in recent studies2. Diagnostic delay has not improved in the time frame of this local study, although AS diagnoses have proportionally increased, likely due to increased use of MRI. Why is the delay not improving? Back pain remains a common presenting complaint in primary care, with lack of recognition of associated extra-articular features. In conclusion, there remains a need for education on when to suspect axial spondyloarthritis and refer to secondary care.
To follow up this study we are holding a series of AS targeted educational meetings with primary care colleagues, a local AS patient support group and regional special interest group. We will assess this intervention and subsequent referrals with the aim of improving confidence in suspected AS cases.
Srensen J, Hetland ML; all departments of rheumatology in Denmark. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis 2015;74:e12.
Sykes M, Doll H, Sengupta R, Gaffney K. Delay to diagnosis in axial spondyloarthritis: are we improving in the UK? Rheumatology 2015;54:2283–2284.
Disclosure of Interest None declared