AB0732 Gendered Issues about Spondyloarthritis. Another CASE Yentl's Syndrome?

Abstract

Background Different presentation of clinic manifestations (signs and symptoms) of Spondyloarthritis (SpA) in women and, its variant in men, Ankylosing Spondylitis (AS), and the lack of specificity of the presentation in women, may result in a lower diagnostic suspicion and a diagnostic error in them, as well as less diagnostic and therapeutic effort prior to specialized health. Objectives To reinforce the differences in signs/symptoms and the diversity of erroneous diagnostics in patients of both sexes finally diagnosed of AS/SpA, together with quantifying the delay in the diagnoses with AS/SpA in both sexes. Methods Retrospective observational design, comparing two groups of patients: 51 men and 28 women diagnosed with Ankylosing Spondylitis and Spondyloarthitis, respectively, at Rheumatology Section, Hospital General Universitario de Alicante (2012-2014). Source: Semi-structured interview on clinical stages of care: symptoms and signs perceived by the patients, conducting clinical history, physical examination and laboratory tests, health care itineraries prior to diagnosis, types of delays, and previous alternative/erroneous diagnostics. A descriptive analysis. Results SpA has been confused with 30 alternative or misdiagnosis in 74.5% of men and 78.6% of women. With recent ASAS criteria, after 2009, more women (21.4%) than men (9.43%) are diagnosed of AS. 26 different types of symptoms are referred by patients with AS (21 in women and 20 in women), 15 of them common in both sexes. Men take an average of 16 months for asking for health care after the onset of symptoms, women take 12 months. Meanwhile, the average of delay in AS diagnosis is 6.8 years in men and 6.1 years in women. Conclusions Not all symptoms are referred with same frequency in both sexes. It should be studied if men report more specific symptoms and women more non-specific. Also, if men describe both signs and symptoms while women only symptoms. In addition, if women report almost-wrong diagnoses that may help to address other types of diagnostic suspicion. Despite the existing knowledge of Spa/AS the non-diagnostic suspicion and the confusiόn with wrong diagnosis underlie the delay in healthcare. ASAS criteria reduce the differences in SpA diagnosis in both sexes. Patients report complex health care pathways, so, it is necessary to check if so many alternative/erroneous diagnosis to SpA/AS are related with the frequency of visits to primary and specialized health system. References van der Horst-Bruinsma IE et al. Ann Rheum Dis 2013;62:789-90. Lee W et al. Ann Rheum Dis 2007;66:633-638. Slobodin D et al. Clin Rheumatol 2011;30:1075-80. Roussou E. Rheumatol Int 2012;32:1597-604. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5563