Healthcare provider (HCP) knowledge gaps and frequent patient presentation with dominant nonaxial symptoms of nonradiographic axial spondyloarthritis (nr-axSpA) may contribute to delayed diagnosis, according to study results published in Clinical Rheumatology.
Study authors conducted interviews of patients with rheumatologist-diagnosed nr-axSpA as well as practicing rheumatologists. Patient interviews explored the diagnostic journey, from initial symptom onset to diagnosis. Rheumatologist interviews focused on barriers and strategies to improve nr-axSpA diagnosis in clinical practice. The main outcome variable was factors impacting time to nr-axSpA diagnosis, assessed using multiple logistic regression analysis.
A total of 25 patients were interviewed. The mean patient age was 45 years and 80% were women. The time taken to diagnose nr-axSpA was over 6 years among 68% of patients, 3 to 5 years among 24% of patients, and 1 to 2 years among 8% of patients.
Delayed diagnosis was more common among women, those who lived in rural locations, completed college, and were not employed full-time.
Interviews revealed that certain patients had early symptoms severe enough to seek medical attention, though these symptoms did not necessarily prompt medical care.
Chronic back pain was not reported as the dominant symptom among most patients. Peripheral joint pain, neck pain, enthesitis, uveitis, and gastrointestinal symptoms were reported to cause greater distress, prompting patients to seek medical care.
Patients with early disease reported feeling their encounters with HCPs were often ineffective, citing physician skepticism towards the validity of their repeated complaints. Additionally, most patients reported seeing multiple HCPs before an nr-axSpA diagnosis was considered and a rheumatology referral placed.
Patients reported encountering long wait times to see a rheumatologist and difficulty finding a physician with expansive knowledge of nr-axSpA.
A total of 16 rheumatologists were interviewed.
Inadequate recognition of inflammatory back pain was reported as a major contributor to delays in nr-axSpA diagnosis. Varying disease presentations and latent symptoms were also noted to complicate timely diagnosis.
Additionally, varying degrees of reliance on imaging for diagnosis of nr-axSpA were reported by rheumatologists. They cited potential inadequate training for reading sacroiliac (SI) joint radiographs and interpretation of axSpA features in magnetic resonance images (MRIs) among radiologists.
This analysis was limited by a predominantly female study population, which may not be representative of the general nr-axSpA population, as well as reliance on patient-reported survey responses.
The study authors concluded, “Targeted HCP education, research into early disease patterns, and interventions sensitive to the broader spectrum of nr-axSpA manifestations are needed to improve timely diagnosis.”
Disclosure: One or more of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Kiwalkar S, Howard R, Choi D, Deodhar A. A mixed methods study to uncover impediments to accurate diagnosis of nonradiographic axial spondyloarthritis in the USA. Clin Rheumatol. Published online June 22, 2023. doi:10.1007/s10067-023-06671-z