Eye Inflammation, Social Vulnerability Linked With Delayed axSpA Diagnosis

A history of uveitis more than doubled the odds of a delayed axial spondyloarthritis (axSpA) diagnosis, according to a study of patients at a single health care system that was published online ahead of print in Arthritis Care & Research. 

“Axial spondyloarthritis patients often experience significant delay between symptom onset and diagnosis for reasons that are incompletely understood. We investigated associations between demographic, medical, and socioeconomic factors and axSpA diagnostic delay,” wrote corresponding author Gregory C. McDermott, MD, of Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, and study coauthors.

Researchers analyzed electronic medical records for 554 patients from the Mass General Brigham health care system who were diagnosed with axSpA between December 1990 and October 2021. Among the patients, the median diagnostic delay— defined as the duration of back pain symptoms reported at diagnosis—was 3.8 years.

The odds ratio for a longer diagnostic delay was 2.77 with a history of uveitis before diagnosis, according to the study. Other factors associated with lengthened diagnostic delay were higher social vulnerability per the US Centers for Disease Control Social Vulnerability Index Atlas (researchers reported a 1.99 odds ratio for patients in the 80-99th percentile) and ankylosing spondylitis at diagnosis (a 1.85 odds ratio).

Conversely, older age at symptom onset and peripheral arthritis were associated with a shorter delay to axSpA diagnosis.

“Patients with higher socioeconomic vulnerability had longer diagnostic delay independent of clinical factors,” researchers wrote.

Reference

McDermott GC, Monshizadeh A, Selzer F, Zhao SS, Ermann J, Katz JN. Factors associated with diagnostic delay in axial spondyloarthritis: impact of clinical factors and social vulnerability. Arthritis Care Res. Published online October 26, 2023. doi:10.1002/acr.25264