Abstract

Diagnostic delay in patients with Axial Spondylarthritis, review of clinical and radiological data - United Arab Emirates (UAE) Experience.

Author(s): Tahir A Khan

Abstract

Spondylarthritis (SpA) is a chronic inflammatory disease characterized by inflammation of the sacroiliac joints and spine, peripheral arthritis, enthesitis, and dactylitis. SpA can manifest mainly as axial SpA (axSpA) or peripheral SpA. AxSpA is divided into radiographic axial spondylarthritis (r-axSpA) and non-radiographic axial spondylarthritis (nr-axSpA). The main symptom of axial spondylarthritis, chronic low back pain, often occurs before the development of sacroiliitis seen on radiographs, and this delay can persist for many years. People with ankylosing spondylitis (AS), who have r-axSpA, tend to experience symptoms for at least a decade before being diagnosed. The late diagnosis of ankylosing spondylitis (AS) is a major challenge in improving patient care.

Objective: To determine the diagnostic delay and to evaluate clinical and radiological features of r-axSpA and nr-axSpA in rheumatology clinics.

Methods: Retrospective analysis of electronic medical records was performed. Patients were classified into two subgroups: r-axSpA and nr-axSpA. The time from the onset of back pain symptoms until the diagnosis of axSpA was defined as the diagnostic delay. Patient characteristics, clinical manifestations, laboratory, and diagnostic imaging results were also compared between subgroups.

Results: A total of 162 patients who fulfilled the ASAS classification criteria for axial SpA were included in the study. 65% of the patients were male, with the age group below 40 years, encompassing 50.6% of the total sample. Patients of Asian origin account for 37.7% of the population, and Emiratis comprise 22.8% of the cohort. The mean delay from symptom onset to diagnosis was an average of 4.67 years before receiving a formal diagnosis by a rheumatologist, as indicated by a standard deviation of 4.35. Of all the patients, 54.9% tested positive for HLAB27, whereas 42.6% were HLAB27 negative.

Conclusion: The mean delay from symptom onset to diagnosis was an average of 4.67 years before receiving a formal diagnosis by a rheumatologist. The time it takes for a diagnosis of axial spondyloarthropathy to be made is significantly less than for the group of patients in the real world.