Axial spondyloarthritis (axSpA) is often delayed or missed as a diagnosis, leading to poor long-term outcomes and decreased quality of life, according to a study published in Clinical Rheumatology.

One of the many reasons for delays in diagnosis or misdiagnosis is that approximately 80% of all adults in the United States experience the primary axSpA symptom — spinal pain — and 13% experience chronic low back pain.

The diagnostic prevalence of axSpA is 0.2% to 0.7%, despite a US population prevalence of 0.9% to 1.4%. The estimated delay for diagnosing axSpA in the United States is 14 years, putting patients at risk for poor outcomes, including irreversible loss of spinal function. Only 37% of US patients are diagnosed with axSpA by rheumatologists. The remaining 63% of diagnoses are made by acute care (3%), pain clinics (4%), orthopedic surgery (4%), chiropractic or physical therapy (7%), primary care (26%), and other settings (19%).

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To reduce delays in diagnosis, study investigators urge clinicians to refer patients with back pain and 1 or more SpA features (current inflammatory back pain, HLA-B27 positivity, MRI/x-ray evidence of sacroiliitis) to a rheumatologist. As non-rheumatologists have a lack of awareness and knowledge of axSpA, public health initiatives are needed to guide chiropractors, physical therapists, primary care physicians, and other specialists to help close the gap between the prevalence rate and diagnosis rate of axSpA.

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Study investigators concluded that “much progress has been made in recent years in understanding the importance of early axSpA diagnosis and in identifying many of the hurdles that contribute to diagnostic delays in the USA. By implementing the tools and strategies outlined in this review, it is hoped that future diagnostic delays will be reduced or eliminated in patients with axSpA.”

Study investigators have received research grants from or have served on advisory boards for AbbVie, Bristol Myers Squibb, Eli Lilly, Janssen, Novartis, Pfizer, and UCB.

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Danve A, Deodhar A. Axial spondyloarthritis in the USA: diagnostic challenges and missed opportunities [published online December 26, 2018]. Clin Rheumatol. doi: 10.1007/s10067-018-4397-3