Delay in diagnosis in Egyptian axial spondylarthritis patients, contributing factors and worldwide stance

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Objectives. Among all rheumatic diseases, axial spondyloarthritis (axSpA) has one of the longest delays between the onset of symptoms and diagnosis. This study aimed to investigate the diagnostic delay in a cohort of Egyptian axSpA patients, specifically the time between symptom onset and access to rheumatology care. Additionally, we aimed to analyze the factors associated with this delay and compare it to diagnostic delays observed in different countries and regions around the world. Material and methods. This cross-sectional study included 51 axSpA patients diagnosed according to the Assessment of Spondyloarthritis International Society (ASAS) criteria. All participants underwent a comprehensive assessment including history taking, clinical examination, review of laboratory and radiological investigations, and treatment. Activity and functional indices were also applied. We conducted correlative studies to analyze factors associated with the delay in diagnosis. Participants were divided into two groups: early diagnosis and late diagnosis, with a cutoff of 5 years. The two groups were compared regarding demographic data, clinical findings, activity, and functional indices. Relations between the groups were assessed using the independent samples t-test or Mann-Whitney’s test for numerical variables. Results. The median (IQR) diagnostic delay was 7 years (3-10 years). Patient age was significantly correlated with diagnostic delay (P = 0.004). Comparison of the early and late diagnosis groups revealed that older patients were more likely to receive an earlier diagnosis. Conclusions. A significant delay in the diagnosis of axSpA persists among Egyptian patients. This delay is correlated with disease duration and is more likely to occur when non-rheumatologists are consulted first.

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