Diagnostic Delays, Misdiagnoses Common With Axial Spondyloarthritis

Only 20% of patients with axial spondyloarthritis saw a rheumatologist for their initial specialist consultation, leading to diagnostic delays and misdiagnoses, according to a single-center study published online ahead of print in the journal Romanian Journal of Internal Medicine.

“The vast majority of patients were initially evaluated by health care providers other than rheumatologists and mostly diagnosed with fibromyalgia,” wrote researchers from the division of rheumatology at Pamukkale University, Denizli, Turkey. “Efforts to increase awareness and to educate first health care providers may shorten the diagnostic delay time.” 

The retrospective study included 266 patients with axial spondyloarthritis who were ultimately referred to the university’s rheumatology department. Researchers investigated physician-related diagnostic delay, or the time from back pain onset until axial spondyloarthritis diagnosis, for two subgroups: 213 patients with ankylosing spondylitis (AS), and 53 patients with non-radiographic axial spondyloarthritis (nr-axSpA). 

“The diagnostic delay time was significantly longer for AS patients [6 ± 8.14 years vs 1.62 ± 2.54 years]” compared with patients with nr-axSpA, researchers reported. 

For 40.9% of patients, initial specialist consultations were with physical therapy and rehabilitation specialists. Nearly 30% saw a neurosurgeon for their initial specialist consultation, while 19.9% started with a rheumatologist. Patients with nr-axSpA were more likely to see physical therapy and rehab specialists than patients with AS, according to the study. 

Some 52.6% of patients were initially diagnosed with fibromyalgia, 28.9% with AS, 12.7% with lumbar disc hernia, and 4.5% with nonspecific low back pain. The accuracy of a first diagnosis was more common for patients with nr-axSpA compared with patients with AS, researchers found. 

“It is well known that early diagnosis and timely treatment improve symptoms and function  among young adults with axial spondyloarthritis,” they wrote. “As a result of diagnostic delay, patients more commonly experience functional limitations and disability. We must work  to increase awareness among non-rheumatologist health care providers.”  

—Jolynn Tumolo 

Reference:

Ulutaş F, Çobankara V, Şenol H, et al. A single center experience: Physician related diagnostic delay and demographic and clinical differences between patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis [published online ahead of print, 2021 Jan 29]. Rom J Intern Med. 2021;10.2478/rjim-2021-0004. doi:10.2478/rjim-2021-0004