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Impact of gender, work, and clinical presentation on diagnostic delay in Italian patients with primary ankylosing spondylitis

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Abstract

The variability of demographic, social, genetic, and clinical factors might influence the time between the onset of symptoms and the diagnosis [diagnostic delay (DD)] of ankylosing spondylitis (AS) in different geographic areas. Different clinical manifestations in men and women affected by AS might indicate a possible role of gender in DD. The aim of the present study was to investigate the influence of demographic, social, genetic, and clinical factors on DD and the differences of DD between men and women related to the presence of different demographic, social, clinical, and genetic parameters in an Italian cohort of primary AS patients. A total of 135 Italian primary AS patients (45 female and 90 male, 27.9 ± 0.89 years old at onset) were studied. The DD, gender, education and work (manual or non-manual) levels, and type of first clinical presentation (inflammatory back pain, arthritis, enthesitis) at onset, family history of AS, and HLA B27 presence were analyzed. The DD (8.744 mean ±0.6869) was significantly higher in men (p = 0.0023), in axial presentation (p = 0.0021), and in manual work (even if with low significance, p = 0.047). The lower DD in women in comparison to that in men was likely related to higher education (p = 0.0045) and work (p = 0.0186) levels, peripheral involvement (p = 0.0009), and HLA B27 positivity (p = 0.0231). DD was higher in AS patients: male, employed in manual jobs, and with axial symptoms at onset. In men, DD seemed to be negatively influenced by lower level of education and work, axial clinical presentation, and HLA B27.

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Abbreviations

AS:

Ankylosing spondylitis

DD:

Diagnostic delay

DMC:

Dunn’s multiple comparison test

GPs:

General practitioners

IBP:

Inflammatory low back pain

KW:

Kruskal-Wallis

MW:

Mann–Whitney

SpA:

Spondyloarthritis

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Funding

This study was not supported by research funding

Disclosures

None.

Author’s contribution

All authors had a substantial role in this study and have read and agreed to the content of manuscript before submission. We thank Dr. Mario Pagano for his free technical informatics support. No other contribution or writing assistance that does not meet the criteria for authorship is included in this study

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Authors and Affiliations

  1. Rheumatology Division, Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini 18, Florence, 50139, Italy

    F. Bandinelli, G. Salvadorini & M. Matucci-Cerinic

  2. Rheumatology Division, Department of Internal Medicine, University of Pisa, Pisa, Italy

    A. Delle Sedie, L. Riente & S. Bombardieri

Authors
  1. F. Bandinelli
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  2. G. Salvadorini
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  3. A. Delle Sedie
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  4. L. Riente
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  5. S. Bombardieri
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  6. M. Matucci-Cerinic
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Corresponding author

Correspondence to F. Bandinelli.

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Bandinelli, F., Salvadorini, G., Sedie, A.D. et al. Impact of gender, work, and clinical presentation on diagnostic delay in Italian patients with primary ankylosing spondylitis. Clin Rheumatol 35, 473–478 (2016). https://doi.org/10.1007/s10067-015-3005-z

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  • DOI: https://doi.org/10.1007/s10067-015-3005-z

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