Trends to shorter diagnostic delay in spondyloarthritis patients during the last decades and association with clinical presentation: data from ASAS-COMOSPA study

Abstract

Background: Diagnostic delay is one of the greatest challenges in spondyloarthritis (SpA). Better disease knowledge and more accessibility to new image technology could have a positive impact on time to diagnosis.

Objectives: The objectives are (1) to evaluate trends in time to diagnosis in SpA patients during the last decades and (2) to determine the association between clinical presentation and diagnostic delay.

Methods: Cross-sectional, retrospective international study, including 3984 patients with SpA diagnosis.

Statistical analysis: Delay in diagnosis was calculated and patients were stratified according to decade of disease onset and initial clinical presentation. Multivariate logistic model, using an early diagnosis (≤2 years) as dependent variable was used. P value<0.05 was considered statistically significant. A possible interaction between decade of disease onset and initial clinical presentation was performed.

Results: The overall median delay from disease onset to SpA diagnosis was 2.9 (p25-75=0.3-9.8) years. Diagnostic delay showed a progressive decrease during the last decades, patients with disease onset after 2010 showed a shorter delay in diagnosis than those with disease onset during 2000-2010 (m 2.00 vs 0.41 years, p<0.01). Age at disease onset (OR 1.02), axial symptom (OR 16.25), peripheral arthritis (OR 6.81), decade at disease onset (OR 3.80) and extra-musculoskeletal manifestation (OR 2.89) were associated with an early diagnosis, while female gender (OR 0.66) was inversely associated.

Conclusions: The proportion of patients with early SpA diagnosis improve from 15% before 1980 to 88% when first symptoms occurred after 2010. Type and number of initial clinical presentation were independent predictors of time to diagnosis.

Keywords: Arthritis, Psoriatic; Axial Spondyloarthritis; Classification; Epidemiology.

Figure 1. Time to spondyloarthritis diagnosis stratifying patients according to date of disease onset.

Figure 2. Proportion of patients with an early spondyloarthritis diagnosis (≤2 years) according to initial clinical manifestation and decade of disease onset.

Figure 3. Multivariate models assessing probability of early spondyloarthritis diagnosis (≤2 years) for each decade of disease onset. Shaded regions correspond to variables statiscally significant.

Figure 4. Proportions of patients with early spondyloarthritis diagnosis in different continents stratified by decades.