Ankylosing spondylitis: an Australian experience

Abstract

The clinical expression of AS in this first-described Australian cohort is similar to previously described cohorts. We observed greater cervicothoracic mobility and a higher enthesitis index among women perhaps contributing to longer delay to diagnosis.

Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis

“…Although 9 papers mention the concepts of social events 21,47 , social support 21,42 , social system 21 , social situation 27,30 , effect and consequences 11,21 , social status 15,21,23,28 , social domain and function 31 , and quality of life 21,31 , they are not in relation to social/sex-related causes explaining sex differences in delay in diagnosis. Only Aggarwal in 2009 adequately discussed the complex range of sex factors involved in the diagnostic process of SpA according to sex 8 .…”

“…Delay in diagnosis of SpA has been described in women 5,9,10 and in both sexes 6,7,[11][12][13][14][15][16]20,26,27,29,30,32,33,35,38,39,40,44,45,46 , and although Bandinelli 23 observed less diagnostic delay in women than in men, in most of the papers where delay was compared between men and women, it was greater in women 8,17,18,19,21,22,28,31,34,37,41,42,43,47,48 . This implies that patients have had medically unsolved disorders for a long time, have continued searching for a diagnosis and treatment, or are being erroneously diagnosed and managed 49 .…”

“…Table 1 shows the main characteristics of the 42 studies on diagnostic delay in SpA included in this systematic review 1,2,3,[8][9][10][11][12][13][14][15][16][17][18]19,20,21,22,23,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47]48 . The review included 23,883 patients (67.6% men, 32.3% women).…”

“…Although the disability rate is worse in women than in men at all ages 17 , women are identified as less disabled and with better spinal mobility than men 42 . These differences and the slower progression of radiological changes in women may influence earlier diagnosis in men, because the spine is more severely affected in them 31 .…”

“…Some symptoms of SpA, such as low back pain, morning stiffness, and sleep disorders associated with pain are shared with fibromyalgia (FM) 18 and have traditionally been assigned low status in the cultural hierarchy of medicine. Often, these symptoms in women are not regarded as having the same meaning as similar symptoms in men and they are not usually considered in the differential diagnosis of SpA, in spite of sometimes coexisting with enthesitis and peripheral arthritis 8 , sometimes misdiagnosed as FM 36,42 . Further, SpA in women may be confused and patients referred to gynecology, surgery, gastroenterology 36 , or psychiatry 10 .…”