Vanina Masson Behar1, Maxime Dougados2, Adrien Etcheto2, Sarah Kreis3, Stéphanie Fabre4, Christophe Hudry2, Sabrina Dadoun3, Christopher Rein3, Edouard Pertuiset5, Bruno Fautrel3, Laure Gossec6. 1. Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France; AP-HP, Paris Descartes University, Rheumatology, Cochin Hospital, 75014 Paris, France. 2. AP-HP, Paris Descartes University, Rheumatology, Cochin Hospital, 75014 Paris, France. 3. Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France. 4. Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France; René-Dubos Hospital, 95300 Pontoise, France. 5. René-Dubos Hospital, 95300 Pontoise, France. 6. Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France. Electronic address: laure.gossec@aphp.fr.
Abstract
OBJECTIVES: The diagnostic delay of axial spondyloarthritis (axSpA) is usually reported to be more than seven years but may have decreased recently. The objective was to quantify the diagnostic delay in patients with axSpA in France and to explore its associated factors. METHODS: Two cross-sectional observational studies included consecutively patients with axSpA (according to both ASAS criteria and rheumatologist expert opinion). Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Potential predictive factors of diagnostic delay analyzed by multiple linear regression were demographic factors, HLA B27 status, year of diagnosis, clinical presentation and sacroiliitis on MRI or radiography. RESULTS: In all, 432 patients were analyzed: the mean age at diagnosis was 34.2 (standard deviation, 12.5) years, the mean disease duration at the time of the assessment was 11.4 (10.4) years. In all, 66.7% were HLA B27 positive, and 70.2% had radiographic sacroiliitis. The mean diagnostic delay was 4.9 (6.3) years, with a median of 2.0 years (interquartile range, 1-7; range: 0-43). In multivariable analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta=0.13; P<0.001), less frequent peripheral arthritis or dactylitis (beta=-1.69; P=0.005), and more frequent entheseal pain (beta=1.46; P=0.015). CONCLUSION: The median diagnostic delay was 2 years indicating diagnostic delay may be for most patients shorter than previously reported. A more "typical" SpA clinical presentation was associated with a shorter diagnostic delay, whereas sacroiliitis and HLA B27 positivity were not associated with this delay.
OBJECTIVES: The diagnostic delay of axial spondyloarthritis (axSpA) is usually reported to be more than seven years but may have decreased recently. The objective was to quantify the diagnostic delay in patients with axSpA in France and to explore its associated factors. METHODS: Two cross-sectional observational studies included consecutively patients with axSpA (according to both ASAS criteria and rheumatologist expert opinion). Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Potential predictive factors of diagnostic delay analyzed by multiple linear regression were demographic factors, HLA B27 status, year of diagnosis, clinical presentation and sacroiliitis on MRI or radiography. RESULTS: In all, 432 patients were analyzed: the mean age at diagnosis was 34.2 (standard deviation, 12.5) years, the mean disease duration at the time of the assessment was 11.4 (10.4) years. In all, 66.7% were HLA B27 positive, and 70.2% had radiographic sacroiliitis. The mean diagnostic delay was 4.9 (6.3) years, with a median of 2.0 years (interquartile range, 1-7; range: 0-43). In multivariable analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta=0.13; P<0.001), less frequent peripheral arthritis or dactylitis (beta=-1.69; P=0.005), and more frequent entheseal pain (beta=1.46; P=0.015). CONCLUSION: The median diagnostic delay was 2 years indicating diagnostic delay may be for most patients shorter than previously reported. A more "typical" SpA clinical presentation was associated with a shorter diagnostic delay, whereas sacroiliitis and HLA B27 positivity were not associated with this delay.
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Authors: Anna Molto; Laure Gossec; Marie-Martine Lefèvre-Colau; Violaine Foltz; Romain Beaufort; Jean-Denis Laredo; Pascal Richette; Philippe Dieude; Philippe Goupille; Antoine Feydy; Maxime Dougados Journal: RMD Open Date: 2019-05-28