medwireNews: The average wait for an axial spondyloarthritis (axSpA) diagnosis is more than 7 years, but the delay varies across Europe and is higher for women and people who develop symptoms at a younger age, real-world study findings indicate.
Marco Garrido-Cumbrera (Universidad de Sevilla, Spain) and co-investigators say their data highlight “a need for continuing efforts dedicated to recognition of patients with a high probability of axSpA on the level of non-rheumatology specialists and facilitating referral to a rheumatologist for timely diagnosis.”
The European Map of Axial Spondyloarthritis study included data from 2652 people with axSpA from 13 European countries who responded to an online survey between 2017 and 2018.
The researchers report in Rheumatology that the mean age at onset of symptoms (pain, inflammation, and/or stiffness) among the respondents was 26.6 years whereas the mean age at diagnosis was 34.1 years.
The resulting diagnostic delay was 7.4 years on average, which Garrido-Cumbrera et al say “are seven years of intermittent pain, inflammation, fatigue, numerous medical tests, unnecessary visits to specialists, uncertainty, anxiety, depression and impact on quality of life.”
The average diagnostic delay was significantly higher for women than men (8.2 vs 6.1 years) and for individuals who were diagnosed by a rheumatologist rather than other healthcare professionals (HCPs; 7.9 vs 5.7 years).
The delay was also significantly longer when symptoms presented at a younger age (mean 12.7 vs 1.9 years for age <18 vs 52–70 years) and increased with increasing numbers of HCPs seen before diagnosis (mean 9.4 vs 6.5 years for ≥3 vs 0 HCPs).
Female sex and age at symptom onset remained significantly associated with diagnostic delays in multivariable analysis. In addition, there was a significant interaction between female sex and the number of HCPs seen before diagnosis, such that diagnostic delay was associated with a significantly higher number of HCPs seen in women but not men.
Garrido-Cumbrera and team suggest that this “might be due to the fact that in women with back pain, axSpA is often considered as unlikely diagnosis that results in the referral to healthcare professionals other than rheumatologists.”
The investigators also note that the mean diagnostic delay varied substantially throughout Europe, ranging from 2.6 years in the UK to 10.6 years in Norway.
The authors conclude that the length of diagnostic delay among “axSpA patients in Europe is unacceptable and undoubtedly impacts on many aspects of the health condition and life of the patient. Thus, solutions for its reduction must be found urgently.”
They add: “Understanding that the number of HCPs visited before diagnosis is strongly associated with [diagnostic delay], suggests that both HCP education and effective referral practices are key to decreasing [diagnostic delay] in axSpA.”
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Rheumatology 2021; doi:10.1093/rheumatology/keab369