The Delay of Diagnosis in Spondyloarthropathy Patients in a Tertiary Hospital in Saudi Arabia.

Abstract

ObjectiveSeronegative spondyloarthropathies (SpA) are a group of rheumatological disorders that share the common feature of being rheumatoid factor negative. Inflammation of the sacroiliac joint is considered the hallmark of ankylosing spondylitis (AS). On the other hand, psoriatic arthritis (PsA) affects patients with psoriasis. It is characterized by asymmetrical oligoarticular arthritis. Involvement of the distal interphalangeal joint is a unique feature of PsA. Enteropathic arthritis (EnA) involves the presence of inflammatory arthropathy in patients with inflammatory bowel disease (IBD). These diseases are strongly associated with the HLA-B27 gene. Although they are significantly disabling, their diagnosis has been frequently delayed. Early diagnosis is associated with early treatment, and thus better disease outcomes. The aim of this study was to evaluate the diagnostic delay (DD), that is, the duration between onset of symptoms and diagnosis, of SpA patients and its relation to the demographic characteristics, disease activity, measured by ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis disease activity index (BASDAI) scores, and the HLA-B27 status of Saudi SpA patients.MethodsThe data of 94 patients who were diagnosed with SpA were collected from medical records and from them personally. The data included patient demographics, age at diagnosis, delay of diagnosis, in years, disease activity (BASDAI and ASDAS scores), HLA-B27 status and C-reactive protein levels (CRP). The data were analyzed using Statistical Package for the Social Sciences for Windows version 21.0 (SPSS Inc., Chicago, IL, USA).Results50% of patients were females. The mean DD was (mean ± SD) 4.98 ± 6.00 (range: 0-35). The average age of symptoms onset was 30.70 ± 11.30 (range: 8-59) and the average age at diagnosis was 35.65 ± 10.80 (range: 16-60). The mean BASDAI and ASDAS scores were 3.05 ± 2.21 and 2.29 ± 1.01, respectively. The majority of the patients had high disease activity (35.1 %). 25.0% were HLA-B27 positive. 83.7 % had normal CRP. There was no statistically significant difference between DD and gender, HLA-B27 status, ASDAS and BASDAI scores, and CRP. The DD was significantly higher in AS patients when compared to PsA (p-value= 0.048) and EnA patients (p-value < 0.0001). There was a statistically significant weak anticorrelation between DD and the age at symptoms onset in PsA patients (r-value= -0.39, p-value= 0.003). Age at diagnosis was statistically significantly higher in patients with PsA when compared to EnA. There was no correlation between DD and the disease activity in SpA patients.ConclusionThe means of DD in AS, PsA, and EnA patients were 6.69 ± 5.83, 3.67 ± 6.42 and 2.00 ± 1.60, respectively. DD was greater in AS patients when compared to PsA and EnA patients. Early detection and referral to rheumatologists should be addressed, as early intervention is associated with favorable disease outcomes.