Diagnostic Delays in Spondyloarthritis Still Prolonged Save

Previously quoted average  delay in diagnosing axial spondyloarthritis (axSpA) may be improving as a recent UK study shows the mean average time to diagnosis in two different NHS trusts was between five and six years. 

The diagnostic delay in axSpA has been attributed to a slower progression rate, younger onset in males, protean back pain symptoms and the fact that most spondylitis is either identified by specialists or by incident radiographic identifcation.

This study examined two urban National Health Service (NHS) rheumatology services to identify the temporal sequences to diagnosis.  Surveys were conducted between  August and November 2021 and were completed either by paper or online.

A  total of 106 patients with an established diagnosis of axial SpA were surveyed using a 14-question survey was to identify the delay to diagnosis and contributing factors.

The mean time from the onset of symptoms to the diagnosis of axial SpA was similar between trusts (Royal Free at 5.72 years and Salford Royal at 5.96 years). Yet there was a difference in the median time to diagnosis - Royal Free at 6.09 years and Salford Royal at 4.27 years.

During the interval from symptom onset to diagnosis, 90% of patients saw their general practitioner (GP) (63% saw a GP 1-5 times, 23% saw 5-10 times and 14% saw more than 10 times). Other HCPs contributed to this delay with 32% seeing one other HCP, 18% two other HCPs, and 19% seeing 3-5 other HCPs prior to diagnosis.

Once referred to secondary rheumatologic are the diagnostic delays were considerably shorter (0.59 and 0.35 years) with rheumatology's time to diagnosis only making up 8.3-12.8% of the total time to diagnosis.

The National Axial Spondyloarthritis Society (NASS) has suggested a “Gold Standard” goal of just one year from symptom to diagnosis in axSpA patients.  More research and education is needed to lower this diagnostic gap.