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Identifying Factors of Delayed Diagnosis in Axial Spondyloarthritis


Although early diagnosis of axial spondyloarthritis is crucial for patients to receive timely access to care and effective treatment, these patients experience a diagnostic delay of more than 7 years, on average.

Early diagnosis of axial spondyloarthritis (axSpA) is crucial for patients to receive timely access to care and effective treatment, but a study of patients from 13 European countries found that patients with axSpA have a diagnostic delay of more than 7 years on average. The findings were presented in an abstract at the European League Against Rheumatism (EULAR)’s annual meeting.

The first symptoms of axSpA can occur at an early age, but the diagnosis can take years, which results in a poorer prognosis and more severe outcomes.

"Symptoms can vary widely and physicians may initially fail to associate them with the disease," John Isaacs, PhD, BSc, MB BS, director of therapeutics, The University of Newcastle, United Kingdom, and scientific chair of the EULAR Scientific Committee, explained in a statement. "Many years can pass until the correct diagnosis is made. It is important, however, to detect and accordingly treat the disease as early as possible. Timely treatment can help to prevent permanent damage to bones and joints."

The researchers analyzed data from patients in the European Map of Axial Spondyloarthritis study, which utilized an online survey across 13 countries. The study investigated factors that impact the time to diagnosis.

A total of 2846 patients participated and 2652 provided information for calculating diagnostic delay. Although the mean (SD) age at symptom onset was 26.6 (11.1) years, the mean age at diagnosis was 33.7 (11.5) years. The delay on average was 7.4 years, but it could take as long as 15 years.

Older age, female gender, and receiving a diagnosis from a rheumatologist were all associated with longer diagnostic delay in a bivariate analysis. However, in the multivariate regression, younger age at symptom onset and the number of health care providers (HCPs) seen before were associated with a diagnostic delay.

Overall, the number of medical professionals involved prior to diagnosis was most strongly associated with diagnostic delay, because these professionals proposed incorrect diagnoses that delayed the time it took to arrive at a correct diagnosis by a rheumatologist.

“The fact that one of the most strongly associated parameters to diagnostic delay was number of HCPs seen before diagnosis suggests the need for urgent action to reduce incorrect referrals to shorten the patient journey to diagnosis across Europe,” the authors concluded.


Garrido-Cumbrera M, Navarro-Compán V, Bundy C, et al. Identification of parameters associated with a diagnostic delay in axial spondyloarthritis: results from the European Map of Axial Spondyloarthritis. Presented at: EULAR 2020; June 3-6, 2020; Abstract OP0278. https://ard.bmj.com/content/79/Suppl_1/173

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