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  1. D. Poddubnyy1,2,
  2. M. Garrido-Cumbrera3,4,
  3. F. Sommerfleck5,
  4. V. Navarro-Compán6,
  5. C. Bundy7,
  6. S. Makri8,
  7. J. Correa-Fernández3,
  8. S. M. Akerkar9,
  9. J. Davies10,
  10. L. Christen11,
  11. E. Karam12
  1. 1Charité-Universitätsmedizin Berlin, Rheumatology Department, Berlin, Germany
  2. 2German Rheumatism Research Centre, Rheumatology Department, Berlin, Germany
  3. 3Universidad de Sevilla, Health & Territory Research (HTR), Seville, Spain
  4. 4Spanish Federation of Spondyloarthritis Associations (CEADE), Patient Advocacy, Madrid, Spain
  5. 5Sanatorio Julio Mendez, Rheumatology Department, Buenos Aires, Argentina
  6. 6IdiPaz, Hospital Universitario La Paz, Rheumatology Department, Madrid, Spain
  7. 7Cardiff University, Rheumatology Department, Cardiff, United Kingdom
  8. 8Cyprus League for People with Rheumatism (CYLPER), Patient Advocacy, Nicosia, Cyprus
  9. 9Mumbai Arthritis Clinic, Rheumatology Department, Mumbai, India
  10. 10Axial Spondyloarthritis International Federation (ASIF), Patient Advocacy, London, United Kingdom
  11. 11Novartis Pharma AG, Patient Engagement, Basel, Switzerland
  12. 12Canadian Spondylitis Association (CSA), Patient Advocacy, Toronto, Canada


Background Despite efforts for early detection, delayed diagnosis in axial spondyloarthritis (axSpA) remains an unresolved challenge.

Objectives This analysis aimed to assess diagnostic delay and its associated factors around the world in a large sample of patients included in the International Map of Axial Spondyloarthritis (IMAS).

Methods IMAS is a cross-sectional online survey (2017-2022) including 5,557 unselected axSpA patients from 27 countries. Diagnostic delay was calculated as the difference between age at diagnosis and age at symptom onset reported by patients. The independent factors evaluated were: age at symptom onset, disease duration, gender, education level, diagnosed by rheumatologist, number of healthcare professionals (HCPs) seen before diagnosis, HLA-B27, uveitis, and inflammatory bowel disease. The factor world region was introduced as a dummy variable taking Europe as the reference region due to its larger sample size and diagnostic delay close to the overall mean. The Mann-Whitney, Kruskal-Wallis test and Pearson correlation were used to evaluate the differences in diagnostic delay and independent variables. Associations between diagnostic delay and regions, sociodemographic characteristics, as well as disease-related factors were explored through univariable and multivariable linear regression analysis.

Results Data from 5,327 patients who reported data to calculate diagnostic delay in IMAS survey were analyzed: 3,231 were from Europe, 770 from North America, 600 from Asia, 548 from Latin America, and 146 from Africa. Overall, patients reported a diagnostic delay of 7.4 years (median: 4.0) since symptom onset, with substantial variation across regions, being the highest in South Africa and the lowest in Asia (Figure 1). Furthermore, mean disease duration was 17.1 ± 13.3. Patients with longer diagnostic delay were more frequently female, younger at symptom onset, with more years with the condition, more commonly diagnosed by the rheumatologist, with a higher number of HCPs seen before diagnosis, had experienced uveitis, and inflammatory bowel disease. The variables independently associated with longer diagnostic delay in the final multivariable regression model were: younger age at symptom onset (b=-0.100), more disease duration (b=0.363), female gender (b=2.274), being diagnosed by rheumatologist (b=1.163), higher number of healthcare professionals (HCPs) seen before diagnosis (b=1.033), and presence of uveitis (b=1.286; Table 1).

Conclusion In this global sample of axSpA patients, the mean diagnostic delay was 7.4 years, and had significant differences across regions. Younger age at symptom onset, longer disease duration, female gender, diagnosed by rheumatologist, higher number of HCPs seen before diagnosis, and the presence of uveitis were the parameters associated with a longer diagnostic delay in axSpA patients.

Figure 1.

Mean and median diagnostic delays by region (N= 5,327)

Table 1.

Univariable and multivariable linear regression analysis of the association between diagnostic delay and independent variables in patients with axial spondyloarthritis (N= 4,595)

Acknowledgements This study was supported by Novartis Pharma AG. The authors would like to thank all patients who participated in the study.

Disclosure of Interests Denis Poddubnyy Speakers bureau: AbbVie, BMS, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche and UCB, Grant/research support from: AbbVie, MSD, Novartis, and Pfizer, Marco Garrido-Cumbrera Grant/research support from: Novartis, Fernando Sommerfleck Speakers bureau: Abbvie, Eli Lilly, Janssen, Novartis, Consultant of: Abbvie, Novartis, Janssen, Victoria Navarro-Compán Speakers bureau: AbbVie, Eli Lilly, Janssen, MSD, Novartis, Pfizer, UCB Pharma, Consultant of: AbbVie, Eli Lilly, Galapagos, MoonLake, MSD, Novartis, Pfizer, UCB Pharma, Grant/research support from: AbbVie, Novartis, Christine Bundy Speakers bureau: AbbVie, Celgene, Janssen, Lilly, Novartis and Pfizer, Souzi Makri Consultant of: Novartis, GSK and Bayer, José Correa-Fernández: None declared, SHASHANK MURLIDHAR AKERKAR Speakers bureau: Pfizer, Novartis, Eli Lilly, Jansen, Jo Davies Grant/research support from: No personal funding, but ASIF has received funding from Novartis, UCB, Lilly, Abbvie, Boehringer Ingleheim, Pfizer, Janssen, Laura Christen Employee of: Novartis employment and stock ownership, Elie Karam: None declared.

  • Patient reported outcomes
  • Spondyloarthritis
  • Diagnostic Tests

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