One-Third of Patients With axSpA Experienced 5 Years of Symptoms Before Assessment

Four out of five of patients with axial spondyloarthritis (axSpA) experienced symptoms for more than 6 months before their initial rheumatology assessment—and one-third reported experiencing symptoms for more than 5 years. Results from the UK-based study were published in the journal Rheumatology.

“There is a growing body of evidence that delayed axSpA diagnosis is associated with worse clinical, humanistic, and economic outcomes,” researchers wrote, “while treatment with TNF [tumor necrosis factor] inhibitors has been shown to improve clinical outcomes and radiographic progression more effectively when commenced earlier in the disease process.”

In recent years, updated international guidelines have aimed to reduce diagnostic delay in patients with axSpA. Researchers used data from the National Early Inflammatory Arthritis Audit (NEIAA) to gauge the current time to diagnosis for 784 patients with axSpA compared with 9720 patients with rheumatoid arthritis and 370 with mechanical back pain. Patients lived in England and Wales and were recruited to the NEIAA between May 2018 and March 2020.

Patients with axSpA experienced symptoms for significantly longer periods than patients with rheumatoid arthritis, and non-significantly longer than those with mechanical back pain, before their initial rheumatology assessment, the study found. Symptom duration of more than 6 months occurred in 79.7% of patients with axSpA, compared with 33.7% of patients with rheumatoid arthritis and 76% of patients with back pain. Some 32.6% of patients with axSpA had experienced symptoms for more than 5 years, compared with 3.5% of patients with rheumatoid arthritis and 24.6% of patients with back pain.

Median time from referral to initial rheumatology assessment was 36 days for patients with axSpA, 24 days for those with rheumatoid arthritis, and 39 days for patients with back pain, according to the study. Among those eligible for more frequent follow-up in an early inflammatory arthritis pathway, disease-specific education was provided to fewer patients with axSpA compared with patients with rheumatoid arthritis.

“As a community, we have learned about the benefits of prompt diagnosis and treatment from across the spectrum of autoimmune diseases. Findings from the NEIAA highlight a subpopulation of patients with rheumatic disease on whom we need to focus more attention,” researchers wrote. “We need to establish parity in relation to timely recognition, referral for assessment, and patient education.”

—Jolynn Tumolo

Reference:
Russell MD, Coath F, Yates M, et al. Diagnostic delay is common for patients with axial spondyloarthritis: results from the National Early Inflammatory Arthritis Audit. Rheumatology. 2022;61(2):734-742.