Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry

Abstract

Background/purposeEarly diagnosis of inflammatory rheumatic diseases is important in order to improve long-term outcome. We studied whether delay in diagnosis (time between onset of symptoms and establishment of diagnosis) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS) changed from year 2000 to 2011.MethodsMonth and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13 721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset and diagnosis was modelled using generalised linear regression to predict the average duration for each calendar year of initial symptoms with adjustments for gender, year of birth and date of DANBIO entry.ResultsPatients with valid data (RA: 10 416 (73%); PSA: 1970 (68%); AS: 1335 (65%)) did not differ significantly from the whole DANBIO population, except more missing data in early years. The regression model showed that the mean duration from initial symptoms to diagnosis for RA, PSA and AS declined steadily from 30, 53 and 66 months (year 2000), respectively, to 3–4 months (year 2011). Sensitivity analyses including patients who were included after 2005, patients who had received biological treatment or had symptom onset less than 2 and 5 years prior to first entry into DANBIO showed similar results.ConclusionSince the year 2000, a significant reduction in diagnostic delay was observed in this large cohort of patients with RA, PSA or AS, probably reflecting a stronger awareness of the importance of early diagnosis.

Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients

“…A recent prospective, multicenter controlled study demonstrated that after specific spondyloarthritis-aimed training, a general practitioner's consideration to refer patients with symptoms of axial and peripheral spondyloarthritis increased by more than 40% [43]. As discussed above, data from the DANBIO registry also suggest marked improvements in the time from symptom onset to diagnosis over recent years [24]. Furthermore, data from two large UK centers show that reported new cases of AS increased by 51% between 2009 and 2013 versus the preceding 5 years [25].…”

“…For PsA, an average delay in diagnosis of 5 years was reported in the MAPP study [7]. Although data from the Danish nationwide DANBIO registry suggest distinct improvements in time from symptom onset to diagnosis in both PsA and AxSpA over the last two decades [24], such changes were not seen in a recent UK study [25] and therefore require further investigation in future studies.…”

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

“…The inclusion criteria were original articles in which SpA was the main subject, which analyzed delay in diagnosis and included women. We excluded papers with PsA patients because, although this disease also shows diagnosis delay, it is less than that found in AS 4 , probably due to the presence of psoriasis in two-thirds of patients prior to arthritis. In addition, papers were excluded if they did not fulfill the study criteria or consisted of editorials, reviews, case studies, questionnaires, or diagnostic/therapeutic techniques.…”

“…Radiological alterations are slow to appear and hence underrecognition or considerable diagnostic delay has been frequent. As a result of the discovery of the association with HLA-B27, the development of classification criteria for the different clinical forms, and probably, closer attention, delay has been reduced in recent years 4 .…”

A Needs-Based Rheumatologist Education Program on Treating to Target in Psoriatic Arthritis and Spondyloarthropathy: Insights and Challenges

“…Data for early identification of PsA and SpA were discussed [11], as was predictors of poor outcomes [12] [13], consequences of diagnostic delay [14], the relationship between skin involvement and PsA risk [15] [16], and available and emerging agents within pathways such as PDE4, IL-12, IL-23, and IL-17.…”