Disclosures: The researchers report funding from Novartis Pharma AG.
May 26, 2021
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Average axial spondyloarthritis diagnosis delayed more than 7 years in Europe

Disclosures: The researchers report funding from Novartis Pharma AG.
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European patients with axial spondyloarthritis wait an average of more than 7 years between the first appearance of symptoms and receiving a diagnosis, according to data published in Rheumatology.

The researchers further concluded that women, those who experienced symptom onset at a younger age and those who saw a greater number of health care professionals experienced longer delays to diagnosis.

European patients with axial SpA wait an average of more than 7 years between the first appearance of symptoms and receiving a diagnosis, according to data derived from Garrido-Cumbrera M, et al. Rheumatology. 2021;doi:10.1093/rheumatology/keab369.

Early diagnosis of axial spondyloarthritis (axSpA), an inflammatory disease characterized by an insidious progression which can cause irreversible structural damage to the spine, is crucial for initiation of optimal treatments that may result in a more favorable prognosis for patients,” Marco Garrido-Cumbrera, PhD, of the University of Seville, in Spain, and colleagues wrote. “However, despite extensive research on the illness, diagnostic delay (DD) in axSpA remains high and in fact, one of the longest among rheumatic diseases.

“In order to establish accurate clinical guidelines that enable early diagnosis, identification of the factors associated with its delay is key,” they added. “Various studies have found different factors associated with increased DD, including female gender, younger age at symptom onset, HLA-B27 negativity, presence of enthesitis or entheseal pain, no family history of SpA, older age at diagnosis, absence of peripheral arthritis or dactylitis, and presence of psoriasis. However, to date, these findings have not been replicated in an international setting.”

Marco Garrido-Cumbrera

To analyze the factors associated with diagnostic delay among patients with axial SpA, Garrido-Cumbrera and colleagues conducted a survey of participants from the European Map of Axial Spondyloarthritis (EMAS). According to the researchers, EMAS was a cross sectional online survey of 2,846 patients with a self-reported diagnosis of axSpA from 13 European countries — Austria, Belgium, France, Germany, Italy, the Netherlands, Norway, Russia, Slovenia, Spain, Sweden, Switzerland and the United Kingdom.

For their own study, Garrido-Cumbrera and colleagues recruited adult patients with self-reported clinician-diagnosed axial SpA and at least one visit to a health care professional for their disease in the 12 months prior to the study. The online survey included 108 items ranging from socio-demographic and anthropometric characteristics, disability assessment, working life, daily life, lifestyle habits, diagnosis information, health care use, treatment, comorbidities, psychological distress and mental health, disease-specific outcomes, disease-related attitudes and treatment goals.

For their analysis, Garrido-Cumbrera and colleagues included data from 2,652 participants who provided information on their ages at symptom onset and diagnosis. Diagnosis delays were calculated as the difference between age at diagnosis and age at symptom onset, reported by participants. The researchers used univariable and multivariable linear regression analyses to assess related factors.

According to the researchers, the average delay in diagnosis was 7.4±8.4years, with a variation between countries. In the final multivariable regression model, younger age at symptom onset (b = –0.26; 95%CI, –0.28 to –0.23), female gender (b=1.34; 95% CI, 0.73-1.96) and a higher number of health care professionals seen prior to diagnosis (b=1.19; 95% CI, 0.95-1.43) were associated with longer delays. The researchers reported a “substantial variation” of diagnostic delay across various countries, with Norway, Sweden and Spain associated with the longest delays.

“Factors associated with a longer diagnostic delay are younger age at symptom onset, female gender, a higher number of HCPs seen prior to diagnosis, and being diagnosed by a rheumatologist,” Garrido-Cumbrera told Healio Rheumatology. “In order to reduce diagnostic delay in axSpA, health care professionals need to take these characteristics into account when seeing a patient with back pain.

“In addition, education for health care professionals and effective referral practices to a rheumatologist are key to decreasing the delay in axSpA diagnoses,” he added. “These results are important as they attempt to provide evidence on one of the issues with the greatest impact on the lives of axSpA patients by analyzing the largest sample of patients from a total of 13 European countries.”