Gregory McDermott, MD, Identifies Barriers to Timely axSpA Diagnosis

Patients with higher socioeconomic vulnerability experienced longer gaps between onset of symptoms and diagnosis for axial spondyloarthritis, according to Gregory McDermott, MD, during his presentation at the American College of Rheumatology (ACR) Convergence meeting in Philadelphia on November 12.

Dr McDermott is a practicing rheumatologist and internal medicine specialist at the Brigham and Women's Hospital in Boston, Massachusetts.

“Determinants of delay are incompletely understood,” Dr McDermott said in the research he conducted with his colleagues. “We investigated the associations between demographic, medical, and socioeconomic factors and axSpA diagnostic delay.”

Through electronic health record (EHR) screening algorithm and medical record review, Dr McDermott and colleagues identified patients with axSpA in a large, multihospital health care system between December 1990 and October 2021. They evaluated the patients’ diagnostic delay and mapped their postal addresses to determine their social vulnerability index (SVI)—an composite measure of poverty, lack of access to transportation, crowded housing, and household income. Duration of delay was categorized into 3 groups: 0-1 years, 1-4 years, and more than 4 years.

After diagnosing for demographic and clinical factors, the investigators found that out of 555 total patients, those with a longer delay were younger at symptom onset. Dr McDermott noted that patients with a median age of 29 years had more than 4 years of diagnostic delay, whereas patients of a median age of 31 years had roughly 1 to 4 years of delay, and patients of a median age of 37 had 0-1 year of delay.

Those with more than 4 years of delay in axSpA diagnosis were more likely to seek ophthalmology care for uveitis prior to diagnosis (27% vs 12%). Longer diagnostic delays were associated with ankylosing spondyloarthrits (OR 2.42, 95%CI 1.69-3.48) and uveitis history (OR 2.43, 95%CI 1.50-4.02). However, shorter diagnostic delays were associated with HLA-B27 positivity (OR 0.68, 95%CI 0.47-0.997), peripheral arthritis (OR 0.68, 95%CI 0.47-0.99), and older age at symptom onset (OR 0.80, 95%CI 0.75-0.86 per 5 years)

Patients who generally experienced longer gaps between symptom onset and diagnosis were in the 80-99th percentile of social vulnerability index, supporting the hypothesis that the financial and demographic status of patients significantly affects the health care they receive.

“Patients with higher socioeconomic vulnerability had longer diagnostic delay independent of clinical factors,” Dr McDermott said. He stated his hope that these findings may help identify education and screening strategies to facilitate timely axSpA diagnosis.

—Priyam Vora

Reference:
McDermott G. Poster 0382. Factors Associated with Diagnostic Delay in Axial Spondyloarthritis: Impact of Clinical Factors and Social Vulnerability. Presented at: American College of Rheumatology Convergence. November 12, 2022.