Trends to Shorter Diagnostic Delay in Spondyloarthritis Patients During the Last Decades and Association with Clinical Presentation: Data from ASAS-COMOSPA Study

Overview

Journal RMD Open

Publisher BMJ Publishing Group

Date 2025 Jan 31

PMID 39890204

Authors

Rodolfo Perez-Alamino

Hernan Maldonado-Ficco

Anna Molto

Christian Waimann

Jose Maldonado-Cocco

Maxime Dougados

Robert Landewe

Desiree van der Heijde

Filip Van den Bosch

Affiliations

Soon will be listed here.

Abstract

Background: Diagnostic delay is one of the greatest challenges in spondyloarthritis (SpA). Better disease knowledge and more accessibility to new image technology could have a positive impact on time to diagnosis.

Objectives: The objectives are (1) to evaluate trends in time to diagnosis in SpA patients during the last decades and (2) to determine the association between clinical presentation and diagnostic delay.

Methods: Cross-sectional, retrospective international study, including 3984 patients with SpA diagnosis.

Statistical Analysis: Delay in diagnosis was calculated and patients were stratified according to decade of disease onset and initial clinical presentation. Multivariate logistic model, using an early diagnosis (≤2 years) as dependent variable was used. P value<0.05 was considered statistically significant. A possible interaction between decade of disease onset and initial clinical presentation was performed.

Results: The overall median delay from disease onset to SpA diagnosis was 2.9 (p25-75=0.3-9.8) years. Diagnostic delay showed a progressive decrease during the last decades, patients with disease onset after 2010 showed a shorter delay in diagnosis than those with disease onset during 2000-2010 ( 2.00 vs 0.41 years, p<0.01). Age at disease onset (OR 1.02), axial symptom (OR 16.25), peripheral arthritis (OR 6.81), decade at disease onset (OR 3.80) and extra-musculoskeletal manifestation (OR 2.89) were associated with an early diagnosis, while female gender (OR 0.66) was inversely associated.

Conclusions: The proportion of patients with early SpA diagnosis improve from 15% before 1980 to 88% when first symptoms occurred after 2010. Type and number of initial clinical presentation were independent predictors of time to diagnosis.

References

Sorensen J, Hetland M . Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis. 2014; 74(3):e12. PMC: 4345887. DOI: 10.1136/annrheumdis-2013-204867. View

Molto A, Etcheto A, van der Heijde D, Landewe R, Van den Bosch F, Bautista Molano W . Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2015; 75(6):1016-23. DOI: 10.1136/annrheumdis-2015-208174. View

Rusman T, van Bentum R, van der Horst-Bruinsma I . Sex and gender differences in axial spondyloarthritis: myths and truths. Rheumatology (Oxford). 2020; 59(Suppl4):iv38-iv46. PMC: 7566372. DOI: 10.1093/rheumatology/keaa543. View

Hay C, Packham J, Ryan S, Mallen C, Chatzixenitidis A, Prior J . Diagnostic delay in axial spondyloarthritis: a systematic review. Clin Rheumatol. 2022; 41(7):1939-1950. PMC: 9187558. DOI: 10.1007/s10067-022-06100-7. View

Yi E, Ahuja A, Rajput T, George A, Park Y . Clinical, Economic, and Humanistic Burden Associated With Delayed Diagnosis of Axial Spondyloarthritis: A Systematic Review. Rheumatol Ther. 2020; 7(1):65-87. PMC: 7021861. DOI: 10.1007/s40744-020-00194-8. View

Hamilton L, Gilbert A, Skerrett J, Dickinson S, Gaffney K . Services for people with ankylosing spondylitis in the UK--a survey of rheumatologists and patients. Rheumatology (Oxford). 2011; 50(11):1991-8. DOI: 10.1093/rheumatology/ker013. View

Dougados M, Baeten D . Spondyloarthritis. Lancet. 2011; 377(9783):2127-37. DOI: 10.1016/S0140-6736(11)60071-8. View

Deodhar A, Mittal M, Reilly P, Bao Y, Manthena S, Anderson J . Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol. 2016; 35(7):1769-76. PMC: 4914524. DOI: 10.1007/s10067-016-3231-z. View

van Onna M, Gorter S, Maiburg B, Waagenaar G, van Tubergen A . Education improves referral of patients suspected of having spondyloarthritis by general practitioners: a study with unannounced standardised patients in daily practice. RMD Open. 2015; 1(1):e000152. PMC: 4623373. DOI: 10.1136/rmdopen-2015-000152. View

10.

Putrik P, Ramiro S, Kvien T, Sokka T, Pavlova M, Uhlig T . Inequities in access to biologic and synthetic DMARDs across 46 European countries. Ann Rheum Dis. 2013; 73(1):198-206. DOI: 10.1136/annrheumdis-2012-202603. View

10.

Gossec L, Kerschbaumer A, Ferreira R, Aletaha D, Baraliakos X, Bertheussen H . EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2023 update. Ann Rheum Dis. 2024; 83(6):706-719. PMC: 11103320. DOI: 10.1136/ard-2024-225531. View

11.

McDermott G, Monshizadeh A, Selzer F, Zhao S, Ermann J, Katz J . Factors Associated With Diagnostic Delay in Axial Spondyloarthritis: Impact of Clinical Factors and Social Vulnerability. Arthritis Care Res (Hoboken). 2023; 76(4):541-549. PMC: 10963166. DOI: 10.1002/acr.25264. View

12.

Sykes M, Doll H, Sengupta R, Gaffney K . Delay to diagnosis in axial spondyloarthritis: are we improving in the UK?. Rheumatology (Oxford). 2015; 54(12):2283-4. DOI: 10.1093/rheumatology/kev288. View

13.

Navarro-Compan V, Benavent D, Capelusnik D, van der Heijde D, Landewe R, Poddubnyy D . ASAS consensus definition of early axial spondyloarthritis. Ann Rheum Dis. 2023; 83(9):1093-1099. DOI: 10.1136/ard-2023-224232. View

14.

Rudwaleit M, Sieper J . Referral strategies for early diagnosis of axial spondyloarthritis. Nat Rev Rheumatol. 2012; 8(5):262-8. DOI: 10.1038/nrrheum.2012.39. View

15.

Feldtkeller E, Khan M, van der Heijde D, van der Linden S, Braun J . Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int. 2003; 23(2):61-6. DOI: 10.1007/s00296-002-0237-4. View

16.

Feldtkeller E, Erlendsson J . Definition of disease duration in ankylosing spondylitis. Rheumatol Int. 2007; 28(7):693-6. DOI: 10.1007/s00296-007-0499-y. View

17.

Rudwaleit M, van der Heijde D, Landewe R, Listing J, Akkoc N, Brandt J . The development of Assessment of SpondyloArthritis international Society classification criteria for axial spondyloarthritis (part II): validation and final selection. Ann Rheum Dis. 2009; 68(6):777-83. DOI: 10.1136/ard.2009.108233. View

18.

Marzo-Ortega H, Navarro-Compan V, Akar S, Kiltz U, Clark Z, Nikiphorou E . The impact of gender and sex on diagnosis, treatment outcomes and health-related quality of life in patients with axial spondyloarthritis. Clin Rheumatol. 2022; 41(11):3573-3581. PMC: 9568456. DOI: 10.1007/s10067-022-06228-6. View

19.

Ramiro S, Nikiphorou E, Sepriano A, Ortolan A, Webers C, Baraliakos X . ASAS-EULAR recommendations for the management of axial spondyloarthritis: 2022 update. Ann Rheum Dis. 2022; 82(1):19-34. DOI: 10.1136/ard-2022-223296. View