Unfamiliarity With NrAxSpa Can Delay Diagnosis for Years

The median time from symptom onset to nonradiographic axial spondyloarthritis (NrAxSpa) diagnosis in the United States was more than three years, during which patients consulted multiple health care providers and rheumatologists, according to study findings published online ahead of print in Clinical Rheumatology.

“Delayed diagnosis was significantly more likely for women and people in rural areas,” wrote corresponding author Sonam Kiwalkar, MD, of the Vancouver Clinic at Washington State University, Vancouver, Washington, and study coauthors.

To understand the diagnostic journey of US patients with NrAxSpa, researchers conducted a mixed methods study that began with interviews with 25 adults with rheumatologist-diagnosed NrAxSpa and 16 rheumatologists. Investigators next examined emerging interview themes in an online survey completed by 186 patients.

The median time between symptom onset and NrAxSpa was 3.25 years, survey responses revealed. Most patients met with four or more different types of health care providers and two or more rheumatologists before receiving their NrAxSpa diagnosis. 

“Both patients and health care providers are unfamiliar with NrAxSpa and its symptoms,” researchers wrote, “lacking understanding that NrAxSpa can occur in young people, females, and those presenting with normal x-rays.”

Factors impeding timely NrAxSpa diagnosis included insidious chronic pain, episodic symptom patterns attributed to activity, symptoms beyond chronic lumbosacral back pain, and unfamiliarity or misperceptions surrounding NrAxSpa among health care providers, radiologists, and rheumatologists, according to the study.

“Education on cardinal features, epidemiology, burden, and benefits of timely NrAxSpa diagnosis is warranted for health care providers who commonly manage back pain,” researchers advised.

Reference: 
Kiwalkar S, Howard R, Choi D, Deodhar A. A mixed methods study to uncover impediments to accurate diagnosis of nonradiographic axial spondyloarthritis in the USA. Clin Rheumatol. Published online June 22, 2023. doi:10.1007/s10067-023-06671-z