Patients with axial spondyloarthritis and psoriatic arthritis often experience diagnostic delays because they are often bounced from one healthcare provider to another for years before receiving the correct diagnosis in a rheumatology clinic, according to a report from Healio Rheumatology.
For this report, researchers at Healio examined four research papers reporting axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA) to determine how diagnostic delay affects these patients.
The researchers observed that there are several reasons that patients are bounced from one provider to the next. For axial SPA, one of the reasons is the non-specific symptoms presented by these patients.
“Inflammatory back pain that occurs from axSpA is uncommon but often presents similar to the majority of non-inflammatory — that is, mechanical or non-specific — low back pain,” Dr. Raja Rampersaud, an Orthopedic surgeon, told Healio.“The lack of response to typical mechanical low back pain treatments will often lead to a patient being bounced or a patient choosing to go from one provider to the next.”
Other reasons for diagnostic delay include uncertainties in the diagnostic criteria, a lack of reliable biomarkers, and shifting epidemiology regarding its prevalence among men and women.
According to one of the reviews published in Rheumatology (Oxford), patients with axial SpA worldwide experience an average diagnostic delay of 6.7 years.
“Indeed, diagnostic delay is a major concern for patients with spondyloarthritis and in particular axial spondyloarthritis,” Dr. Laura Passalent, an advanced practice physiotherapist, told Healio “Some of the factors found to be associated with the delayed diagnosis from this recent review were lower education levels, younger age at symptom onset and a lack of extra-articular manifestations,” she added.
Another critical factor the researchers found is that diagnostic delays are generally worse for women, especially those with non-radiographic axial SpA.
In addition, axial SpA is more likely to present differently in women than men. According to Dr. Passalent, women with axial SpA are more likely to experience more disease activity, fatigue, and peripheral involvement than men.
“In these cases, the quality of life goes down for women,” said Dr. Atul Deodhar of Oregon Health & Science University. He also noted that work productivity issues, absenteeism, and early disability are more common in women than men with axial SpA.
“Their voices are not heard, and they do not get proper treatment,” Dr. Deodhar added.
Dr. Deodhar also stressed the importance of education in addressing the problem of delayed diagnosis of axial SpA, particularly in women.
Finally, researchers at Healio noted that although there are existing diagnostic criteria, many doctors, even radiologists, find it difficult to assess the sacroiliac joint to establish a correct diagnosis.
“It is difficult to examine,” Dr. Deodhar told Healio. “MRI is the best way to assess that joint, but even radiologists are not trained in the United States to know what is real sacroiliitis vs. stress from running.”
The researchers noted all the listed factors increased the burden on the healthcare system.
“When patients are bounced from provider to provider, it incurs system-level costs associated with inappropriate investigations and treatment prescriptions,” Dr. Passalent said.
In conclusion, the researchers suggested that combining research and education for patients, providers, and the public can help reduce diagnostic delays and patient bounce in axial SpA and PsA.