Diagnostic delay is common for patients with axial spondyloarthritis: results from the National Early Inflammatory Arthritis Audit

OBJECTIVES: Updated guidelines for patients with axial spondyloarthritis (axSpA) have sought to reduce diagnostic delay by raising awareness amongst clinicians. We used the National Early Inflammatory Arthritis Audit (NEIAA) to describe baseline characteristics and time to diagnosis for newly-referred patients with axSpA in England and Wales.

METHODS: Analyses were performed on sociodemographic and clinical metrics, including time to referral and assessment, for axSpA patients (n = 784) recruited to NEIAA between May 2018 and March 2020. Comparators were patients recruited to NEIAA with rheumatoid arthritis (RA; n = 9,270) or mechanical back pain (MBP; n = 370) in the same period.

RESULTS: Symptom duration prior to initial rheumatology assessment was longer in axSpA than RA patients (p < 0.001) and non-significantly longer in axSpA than MBP patients (p = 0.062): 79.7% of axSpA patients had symptom durations of more than 6 months, compared to 33.7% of RA patients and 76.0% of MBP patients. Following referral, the median time to initial rheumatology assessment was longer for axSpA than RA patients (36 vs. 24 days; p < 0.001) and similar to MBP patients (39 days; p = 0.30). Of the subset of patients deemed eligible for early inflammatory arthritis pathway follow-up, fewer axSpA than RA patients had disease education provided (77.5% vs. 97.8%), and RA patients reported a better understanding of their condition and treatment.

CONCLUSION: Diagnostic delay in axSpA remains a major challenge despite improved disease understanding and updated referral guidelines. Disease education is provided to fewer axSpA than RA patients, highlighting the need for specialist clinics and support programmes for axSpA patients.