AB0822 FACTORS ASSOCIATED WITH A DELAYED DIAGNOSIS OF SPONDYLOARTHRITIS IN A POPULATION OF THE SOUTH OF MOROCCO

Abstract

BackgroundSpondyloarthropathies are chronic inflammatory diseases with predominant axial involvement. Early diagnosis is a major challenge for physicians. Misdiagnosis and diagnostic delays lead to unnecessary paraclinical investigations, inadequate treatment and to poor outcomes including functional impairment and quality of life.ObjectivesWe assess the diagnostic delay in spondyloarthritis and identify factors associated with it.MethodsA retrospective study including patients diagnosed with spondyloarthritis between 2004 and 2020 according to ASAS 2010 criteria.Diagnostic delay was defined as period between the first symptom and diagnosis establishment. The potential factors predicting the diagnostic delay were explored through univariable and multivariable linear regression analysis, included epidemiological characteristics (age, gender, educational level, socio-economic level), clinical and biological presentation and sacroiliitis (radiographic or in MRI). Events occurring before the diagnostic were also analyzed.ResultsThe study included 276 patients: 146 males (53%) and 130 females (47%) with a sex ratio of 1.1 and the mean age at the diagnostic was 38.87 years. Comorbidities included smoking (33 patients), cardiopathy (3 patients), hypertension (19 patients), diabetes (14 patients) and peptic ulcer (5 patients). The mean duration of symptoms was 2.6 years, and average diagnostic delay was 6.5 years with a median of 2.1 years. In univariable and multivariable linear regression analysis, low socio-economic level (p =0.023) and low educational level (p=0.042) were statistically significant parameters associated with a delayed diagnosis. There was no statistically significant association between the delay of diagnosis and age, clinical presentation or sacroiliitis (radiographic or in MRI). The use of traditional and herbal treatments before consulting a rheumatologist was also associated with a longer delayed diagnosis.ConclusionSpondyloarthropathies have a delayed diagnosis. This delay, also found in other studies, is responsible for persistent disease activity and important functional consequences. In our context, low socio-economic level, low educational level, and the use of traditional unconventional treatment are factors associated with a delayed diagnosis.