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

Abstract

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.

Interval between symptom onset and diagnosis among patients with autoimmune rheumatic diseases in a multi‐ethnic Asian population

“…Pre‐diagnosis interval has been referred to as diagnostic delay, (time) interval or lag time between symptom onset and diagnosis in published studies 9‐14,16,20,42,43 . We did not use the term “delay” because, according to the systematic review by Scott et al, “delay” is not only value‐laden but also inaccurate as many patients do seek medical attention promptly after symptom onset 41 .…”

“…Early diagnosis and treatment in autoimmune rheumatic diseases (ARDs) have been shown to significantly improve clinical outcomes such as higher rates of response and remission and less radiographic progression as well as patient‐reported outcomes such as better health‐related quality of life and lower productivity loss 1‐8 . However, recent studies suggest that prolonged interval from symptom onset to diagnosis and treatment remains an unsolved problem in patients with ARDs worldwide 9‐15 . For example, in patients with rheumatoid arthritis (RA) where this interval is reported to be relatively shorter compared to other ARDs, a systematic review found that the reported interval remained consistently long over the past 2 decades (4 to 24 months) 13 .…”