axSpA: Moving the needle in time to diagnosis Save

The journey to axial spondyloarthritis (axSpA) diagnosis is often prolonged and challenging. Understanding the factors contributing to the delays is important to improve the clinical, psychological, social and economic outcomes. This article reviews the findings from three studies presented at ACR Convergence 2024. Data from the SPACE cohort (abstract 0566), the ASAS-PerSpA study (abstract 0550) and the US Claims data (abstract 0558), allows us to highlight the barriers to early diagnosis of axSpA and identify opportunities for improving early diagnosis and treatment.

The SPACE cohort looked at patients with early axSpA with an average symptom duration of just over one year. Over a third of patients were diagnosed within a two year period. The key findings were that the presence of sacroiliitis on imaging, HLA-B27 positivity and presence of peripheral arthritis contributed to the diagnosis of axSpA. A substantial proportion of patients can receive a diagnosis in less than 2 years after symptom onset. This allows us to bring forward the use of these diagnostic tests in the right clinical context in patients with chronic back pain with HLA-B27 positivity and sacroiliitis on MRI being important determinants for the likelihood of axSpA.

The ASAS-PerSpA study showed that the global mean diagnostic delay (DD)  was 4.5 years with variation across the world. On a positive note, the mean diagnostic time had decreased over time from the 1960s (mean DD 18 years) to the 2000s (mean DD 4.5 years). This trend was consistent across different SpA entities, socio-economic factors and world regions. This analysis is useful to the understanding of the effectiveness of improved diagnostic tools and management strategies in reducing delays.

The US Claims Data analysis found that around 40% of patients experienced a diagnostic delay of five years or more. The median time to diagnosis was 4.4 years. Patients reported a median of 13 back pain episodes before receiving an axSpA diagnosis, with around 60% experiencing ten or more episodes. The diagnostic journey involved various specialists including rheumatology, orthopaedic surgery, dermatology and gastroenterology. The high rates of both primary and secondary delays highlight the pressing need for enhanced medical education regarding inflammatory back pain and recognition of axSpA. The development of streamlined pathways is essential to improve the overall outcomes and mitigate the burden of delayed diagnosis.

The combination of the findings from the SPACE cohort, ASAS-PerSpA and US Claims data analysis, highlights significant insights into the diagnostic timelines for patients with axSpA and SpA overall. These insights underscore the importance of targeted assessments for specific features in clinical practice, which could further improve early diagnosis and management of axSpA.

References

Marques M, van der Heijde D, de Bruin L, van Lunteren M, Landewé R, Minde Fagerli K, Van Oosterhout M, van Gaalen F, Ramiro S. How Early Is Early? Unveiling Time to Diagnosis Since Symptom Onset and Its Determinants in Patients Suspected of Early Axial Spondyloarthritis: Data from the SPondyloArthritis Caught Early (SPACE) Cohort [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9).

Ziade N, Hmamouchi I, López Medina C, Aoun M, Gamal S, Dougados M, Elzorkany B. Is the Diagnostic Delay Getting Shorter with Time for Patients with Spondyloarthritis? Data from the International ASAS-PerSpA Study [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9).

Dubreuil M, Magrey M, Haeffs K, Ivanov E, Gandrup Horan J. Patient Diagnostic Journey and Time to Diagnosis in Axial Spondyloarthritis: A Retrospective Cohort Study Using US Claims Data [abstract]. Arthritis Rheumatol. 2024; 76 (suppl 9).