Objectives There is a need for an early diagnosis in all patients with ankylosing spondylitis (AS). How early we can diagnose AS, if disease begins with low back pain (LBP)?
Methods Were interviewed 74 pts (mean age – 31.6±7,7 yrs) with diagnosis of AS (modified New York criteria) whose disease began with LBP: 51 (68,9%) males and 31 (31,1%) - women. The mean disease duration - 10.9±6,0 yrs (min - 12 months., max. - 25 years).
Results Making diagnosis of AS were observed for the following 3 stages. 1 stage - from the onset of LBP before the first patient visit to the general practitioner (GP). According to our data, the patients visit to the GP on average 1,5±0,7 yrs from the beginning of LBP (min 6 mth, max - 10 yrs). There were identified the following reasons for the late visit to the GP: mild symptoms at presentation LBP had 68 pts (91,9%), most patients (68,4%) had recidivating character of LBP, in 21 pts (28,4%) simulates radiculopathy. Morning stiffness was present in 37 pts (50,0%), only 20 (27,0%) had night pain. LBP quickly reduce after use NSAIDs and taking regular exercise. Stage 2 - referral of patient with LBP to the rheumatologist. The first consulting by rheumatologist was 5,0±4.2 yrs (min - 1 year, max 20 yrs) after the first visit GP. Before consulting by rheumatologist, all patients had visited one or more physician (orthopedist, neurologist and other) who had given them one or more diagnosis. The total number of visits physicians before rheumatologist consulting - 7,0±5,4 times (min 1, max- 25). There was positive correlation between making diagnosis and first visit to the rheumatologist (r=0.9, p=0.001). Stage 3 - correct diagnosis of AS. Mean delay in diagnosis was 1.8±0.5 yrs from first visit to the rheumatologist, because standard radiography of the sacroiliac joints was normal.
Conclusions Early diagnosis of AS may be difficult in the first 1,5 yrs due to a variety of reasons including late visit patients to the GP and mild to moderate symptoms at disease onset. Stage 2 can be shortened by educational programs for GP and other specialists. Stage 3 - is necessary to revise the modified New York criteria, because they limit the diagnosis of AS in the early stages.
Disclosure of Interest None declared
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