Comorbidity burden in axial spondyloarthritis: a cluster analysis

Zhao, Sizheng Steven; Radner, Helga; Siebert, Stefan; Duffield, Stephen; Thong, Daniel; Hughes, David; Moots, Robert J.; Solomon, Daniel H.; Goodson, Nicola

doi:10.1093/rheumatology/kez119

Cited by 53 publications

(41 citation statements)

References 27 publications

(35 reference statements)

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“…47 studies were of AS (including 32 using modi ed New York criteria) and 17 of axSpA (including 11 using the ASAS criteria). Delay ranged from 2.8 years in a small Albanian study (of 54 cases over 6 years), to 11.1 years in a single UK centre [13,14]. The mean delay to diagnosis was 6.7 years overall (95% con dence interval 6.2 to 7.2, I 2 =99%).…”

Section: Diagnostic Delay In Axspamentioning

confidence: 94%

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Zhao

Pittam

Harrison

et al. 2020

Preprint

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Background. Delay to diagnosis in axial spondyloarthritis (axSpA) is longer than many other rheumatic diseases. Prolonged delay has been shown to associate with poorer outcomes including functional impairment and quality of life. Our aims were to describe 1) global variation in delay to diagnosis, 2) factors associated with delay, and 3) differences in diagnostic delay between axSpA and psoriatic arthritis (PsA).Methods. We searched Medline, PubMed, EMBASE and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Delay to diagnosis was defined as years between age at symptom onset and age at diagnosis. We pooled mean diagnostic delay using random-effects inverse variance meta-analysis. We examined variations in pooled estimates using pre-specified subgroup analyses and sources of heterogeneity using meta-regression.Results. A total of 64 studies reported mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% confidence interval 6.2 to 7.2) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delay than those from middle-income countries. Factors consistently reported to be associated with longer delay were: lower education levels, younger age at symptom onset and absence of extra-articular manifestations. Pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95%CI 1.6 to 3.6). Conclusion. For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world, although some countries have reported remarkable improvements. Patient factors (education) and disease presentation (age at onset and extra-articular manifestations) should inform awareness campaigns to improve delay. Targets for improvement should aim to resemble delays in other spondyloarthritis patients.

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Section: Diagnostic Delay In Axspamentioning

confidence: 94%

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Zhao

Pittam

Harrison

et al. 2020

Preprint

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“…38 studies were of AS (including 25 using modified New York criteria) and 18 of axSpA (including 11 using the ASAS criteria). Delay ranged from 2.8 years in a small Albanian study (of 54 cases over 6 years), to 11.1 years in a single UK centre [12,13]. The mean delay to diagnosis was 6.8 years overall (95% confidence interval 6.2 to…”

Section: Diagnostic Delay In Axspamentioning

confidence: 95%

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Zhao¹,

Pittam²,

Harrison³

et al. 2020

Preprint

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Background . Delay to diagnosis in axial spondyloarthritis (axSpA) is longer than many other rheumatic diseases. Prolonged delay has been shown to associate with poorer outcomes including functional impairment and quality of life. Our aims were to describe 1) global variation in delay to diagnosis, 2) factors associated with delay, and 3) differences in diagnostic delay between axSpA and psoriatic arthritis (PsA).Methods . We searched Medline, PubMed, EMBASE and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Delay to diagnosis was defined as years between age at symptom onset and age at diagnosis. We pooled mean diagnostic delay using random-effects inverse variance meta-analysis. We examined variations in pooled estimates using pre-specified subgroup analyses and sources of heterogeneity using meta-regression.Results. A total of 54 studies reported mean diagnostic delay in axSpA patients. The pooled mean delay was 6.8 years (95% confidence interval 6.2 to 7.3) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delay than those from middle-income countries. Factors consistently reported to be associated with longer delay were: lower education levels, younger age at symptom onset and absence of extra-articular manifestations. Pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95%CI 1.6 to 3.6).Conclusion. For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world, although some countries have reported remarkable improvements. Patient factors (education) and disease presentation (age at onset and extra-articular manifestations) should inform awareness campaigns to improve delay. Targets for improvement should aim to resemble delays in other spondyloarthritis patients.

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“…AS is a subtype of axSpA and presents typical radiographic manifestations. AS can cause physiological damage, disability, and neurological deafness [3,4], leading to reduced quality of life (QOL) and placing a substantial financial burden on patients, their families and society [5][6][7]. An American study on the direct and indirect economic burden of patients with AS showed that the average direct medical costs were $2674 during the first year, while the indirect costs were $4945 [8].…”

Section: Introductionmentioning

confidence: 99%

Prevalence of ankylosing spondylitis in a Chinese population: a systematic review and meta-analysis

Zhao

Huang

et al. 2020

Rheumatol Int

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Ankylosing spondylitis (AS) is a common inflammatory rheumatic disease that affects the axial skeleton. In this study, we systematically reviewed Chinese AS epidemiological studies from the past 15 years to elucidate its prevalence and provide scientific data for China's health care system. AS epidemiological research in China was summarized by conducting a literature review. A review and statistical analysis of the literature on the epidemiology of AS in mainland China published from May 2005 to May 2019 were performed via a meta-analysis. We calculated the prevalence of AS and analysed differences by sex, region, and population source using STATA12.0 software. Eleven papers including 122,558 subjects from mainland China were included. Over the past 15 years, the total prevalence of AS in mainland China was 0.29% (95% CI 0.22-0.35%), ranging from 0.42% (95% CI 0.31-0.52%) in males to 0.15% (95% CI 0.13-0.18%) in females; the difference in the prevalence of AS by sex was statistically significant (P < 0.001). The prevalence of AS in both southern and northern China was 0.31% (95% CI 0.21-0.42% and 0.21-0.40%, respectively), with no significant difference noted (P = 0.816 > 0.005). The prevalence of AS in Chinese military populations was 0.27% (95% CI 0.09-0.45%), and in community populations, it was 0.29% (95% CI 0.23-0.35%). There was no statistically significant difference in the prevalence of AS by sampling resource (P = 0.115 > 0.005). The prevalence of AS in China was 0.29% and continues to increase. Sex differences in its prevalence were identified; the prevalence rate was 2.8 times higher in males than in females. Epidemiologists in China should formulate precise scientific investigations to provide additional authoritative epidemiological data for the prevention and treatment of AS.

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Comorbidity burden in axial spondyloarthritis: a cluster analysis

Cited by 53 publications

References 27 publications

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis

Prevalence of ankylosing spondylitis in a Chinese population: a systematic review and meta-analysis

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