Table 3.
Clinical impact of delayed diagnosis of axSpA
| Study | Patient population [N] | Definition of delay, years | Clinical outcome measures | Patient outcomes |
|---|---|---|---|---|
| Nie A, et al. 2018 |
AS [281] |
Continuous | PSQI | Longer delay significantly correlated with higher PSQI scores (β = 0.174; P = 0.001) |
| Zhao J, et al. 2015 |
AS [256] |
≤ 5 vs. > 5 | BASRI-hip | Delay of > 5 years positively associated with more severe hip disease (OR, 2.35 [95% CI, 1.36–4.08]; P = 0.002) |
| Seo MR, et al. 2015 |
AxSpA [94] |
≤ 8 (late diagnosis) vs. > 8 (early diagnosis) |
CRP ESR BASDAI BASFI Modified Schober test Radiographic sacroiliitis III or IV Spine bony change mSASSS ACR functional class III or IV |
Significant differences between late vs. early diagnosis at time of diagnosis: Modified Schober test: median (IQR), 2.7 (1.6–4.4) vs. 6.0 (2.5–6.0) cm; P = 0.03 mSASSS: median (IQR), 21.0 (3.0–42.0) vs. 0 (0–4.5); P < 0.01 Proportion with spine bony changes: 77.4 vs. 44.8%; P < 0.01 Significant differences between late vs. early diagnosis at time of study: BASDAI: median (IQR), 3.4 (2.0–4.9) vs. 2.0 (1.0–4.2); P = 0.01 BASFI: median (IQR), 2.5 (0.3–3.8) vs. 0.7 (0.1–1.4); P < 0.01 Modified Schober test: median (IQR), 2.8 (1.2–4.5) vs. 4.5 (3.3–5.3) cm; P < 0.01 mSASSS: median (IQR), 26.0 (4.8–46.3) vs. 1.0 (0–12.5); P < 0.01 Proportion with spine bony changes: 85.3 vs. 53.6%; P < 0.01 |
| Aggarwal R, et al. 2009 |
AS [70] |
≤ 5.9 vs. > 5.9 |
BASDAI BASFI BASMI |
Patients with delay of > 5.9 years had significantly worse mean (SD) scores than those with delay of ≤ 5.9 years BASDAI: 3.7 (1.8) vs. 2.7 (1.7); P = 0.035 BASFI: 3.8 (2.4) vs. 2.5 (2.1); P = 0.033 BASMI: 3.3 (2.7) vs. 1.5 (2.2); P = 0.012 |
| Gunasekera W, et al. 2014 | AS [106] | Continuous |
BASDAI BASFI BASMI |
BASMI score increased by 0.06 per year of diagnosis delay (P = 0.0002) No significant impact of diagnosis delay on BASDAI or BASFI |
| Sullivan C, et al. 2014 |
AS [92] |
< 4 vs. 5–9 vs. > 10 vs. unknown |
BASDAI BASFI BASMI |
No significant differences in BASDAI, BASFI, or BASMI scores |
| Abdelrahman FI, Mortada M. 2018 |
AxSpA [126] |
Mean (SD) Before 2010: 11.3 (3.9) After 2010: 4.6 (2.8) |
BASDAI BASFI BASMI |
Patients with longer delay had worse mean (SD) scores than those with shorter delay (all P < 0.001): BASDAI: 9.1 (1.4) vs. 4.3 (2.2) BASFI: 9.1 (1.4) vs. 3.9 (2.2) BASMI: 8.9 (1.2) vs. 2.2 (2.0) |
| Ibn YY, et al. 2012 |
AS [100] |
< 5 vs. ≥ 5 |
CRP ESR BASDAI BASFI BASRI Occiput-to-wall distance Chest expansion Schober test |
Patients with delay of ≥ 5 years had significantly greater BASFI (61.4 vs. 51.1) and BASRI (8.4 vs. 5.7) scores and significantly lower chest expansion (2.2 vs. 3.5 cm) and Schober test result (1.7 vs. 2.8 cm) than those with delay of < 5 years (all P < 0.05) Longer diagnostic delay was significantly correlated with: Occiput-to-wall distance: r = 0.317 (P = 0.001) Chest expansion: r = 0.374 (P > 0.001) Schober test: r = −0.368 (P < 0.001) BASFI: r = 0.289 (P = 0.004) BASRI: r = 0.349 (P < 0.001) No impact of diagnostic delay on BASDAI score, ESR, or CRP level |
| Fallahi S, Jamshidi AR. 2016 |
AS [163] |
Continuous |
BASDAI BASFI BASMI Chest expansion Finger-to-floor distance Intermalleolar distance Modified Schober test Cervical rotation Tragus-to-wall distance Sacroiliitis grading |
Longer diagnostic delay significantly correlated with worse outcomes: BASDAI: r = 0.18 (P = 0.026) BASFI: r = 0.23 (P = 0.003) BASMI: r = 0.41 (P < 0.001) Chest expansion: r = −0.38 (P < 0.001) Finger-to-floor distance: r = 0.27 (P < 0.001) Intermalleolar distance: r = −0.18 (P = 0.022) Modified Schober test: r = −0.33 (P < 0.001) Cervical rotation: r = −0.29 (P < 0.001) Tragus-to-wall distance: r = 0.30 (P < 0.01) Sacroiliitis grading: r = 0.16 (P = 0.042) |
| Hajialilo M, et al. 2014 |
AS [60] |
< 3 vs. > 3 |
BASDAI BASFI |
Patients with delay of > 3 years had significantly worse BASFI scores (mean [SD], 4.1 [0.7] vs. 3.3 [1.0]; P = 0.001) but comparable BASDAI scores vs. patients with delay of < 3 years |
| Alayli G, et al. 2015 |
AS [85] |
Continuous |
BASDAI BASFI BASMI mSASSS |
Delayed diagnosis positively correlated with BASFI and BASMI scores and mSASSS but not with BASDAI scores |
| Cakar E, et al. 2009 |
AS [121] |
Mean (SD) No change in work: 3.7 (3.6) Work-disabled, change in job: 7.3 (4.8) Permanently work disabled: 7.8 (6.9) |
CRP ESR BASFI BASDAI BASMI Modified lumbar Schober test Lateral lumbar flexion Chest expansion Chin-to-sternum distance Tragus-to-wall distance Intermalleolar distance |
Patients with longer delay had higher CRP levels and worse mobility than those with shorter delay (mean [SD], no change vs. job change vs. permanently disabled): CRP, mg/L: 11.1 (8.3) vs. 17.6 (22.2) vs. 39.7 (46.4); P = 0.034 Modified lumbar Schober test, cm: 4.3 (1.4) vs. 3.2 (1.3) vs. 2.0 (1.5); P < 0.001 Lateral lumbar flexion, cm: 18.2 (10.8) vs. 14.7 (12.7) vs. 7.8 (3.5); P < 0.001 Chest expansion, cm: 5.5 (2.0) vs. 4.5 (2.1) vs. 2.4 (1.5); P < 0.001 Chin-sternum distance, cm: 0.2 (0.8) vs. 1.3 (1.8) vs. 2.0 (2.4); P = 0.001 Tragus-to-wall distance, cm: 0.6 (1.9) vs. 1.2 (2.5) vs. 6.9 (6.2); P = 0.001 Intermalleolar distance, cm: 113.9 (15.3) vs. 105.3 (17.2) vs. 90.6 (21.3); P < 0.001 BASFI: 3.3 (2.1) vs. 4.6 (2.1) vs. 5.2 (2.5); P = 0.005 BASMI: 1.1 (1.1) vs. 2.4 (1.3) vs. 4.3 (2.3); P < 0.001 |
| Dincer U, et al. 2008 |
AS [111] |
< 3 years vs. > 3 years |
BASDAI BASFI |
No significant differences in BASDAI or BASFI scores |
| Slobodin G, et al. 2011 |
AxSpA [148] |
≤ 1 vs. 1–5 vs. ≥ 5 |
CRP ESR Schober test Finger-to-floor distance Occiput-to-wall distance Chest expansion |
Patients with delay of > 1 year had significantly (P = 0.028) greater occiput-to-wall distance (less spinal flexibility) than those diagnosed within 1 year (mean [SD]: ≤ 1 year, 1.5 [5.4] cm; 1–5 years, 3.7 [2.0] cm; ≥ 5 years, 2.4 [5.3]) |
| Cayetti LA, et al. 2013 |
AS [147] |
≤ 3 vs. > 3 to ≤ 10 vs. > 10 |
BASDAI BASFI BASMI BASRI |
No substantial impact of delay on functional capacity or radiographic damage |
ACR American College of Rheumatology, AS ankylosing spondylitis, axSpA axial spondyloarthritis, BASDAI Bath Ankylosing Spondylitis Disease Activity Index, BASFI Bath Ankylosing Spondylitis Functional Index, BASMI Bath Ankylosing Spondylitis Metrology Index, BASRI Bath Ankylosing Spondylitis Radiology Index, CRP C-reactive protein, ESR erythrocyte sedimentation rate, IQR interquartile range, mSASSS modified Stoke Ankylosing Spondylitis Spinal Score, PSQI Pittsburgh Sleep Quality Index