Diagnostic Delay in Spondyloarthritis

Santiago Scarafia¹, Maria Paula Girard Bosch ², Mariana Benegas ³, Vanesa Cosentino ⁴, Josefina Marin ⁵, Vanesa Duarte ⁶, Juan Bande ⁷, Maria Julieta Gamba ⁸, Fernando Sommerfleck ⁹, Paula Gonzalez ⁸, Diego Vila ¹⁰, Marina Oliver ¹¹, Maria Mercedes Piovesan ¹², Rodrigo Aguila ¹³, Velozo Edson Javier ¹⁴, Eduardo Kerzberg ¹⁵, Maria Janina Tapia Moreira ¹⁶, Micaela Cosatti ¹⁷, Carla Airoldi ¹⁸, Mercedes Garcia ¹⁹ and Maria Victoria Martire ²⁰, ¹Hospital Municipal "San Cayetano", Buenos Aires, Buenos Aires, Argentina, ²Instituto Médico Platense, La Plata, ³Sanatorio Mendez, Buenos Aires, ⁴Federación de Asociaciones de Trabajadores de la Sanidad Argentina Buenos Aires, Buenos Aires, Argentina, ⁵Hospital Italiano de Buenos Aires, buenos aires, Ciudad Autonoma de Buenos Aires, Argentina, ⁶Clínica Monte Grande, Monte Grande, Buenos Aires, Argentina, ⁷Hospital General de Agudos Dr. E. Tornú, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina, ⁸Hospital Nacional Posadas, Buenos Aires, Buenos Aires, Argentina, ⁹Sanatorio Mendez, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁰Centro Médico Ginecológico Zárate, Zárate, Buenos Aires, Argentina, ¹¹Hospital Privado de Comunidad de Mar del Plata, Mar del Plata, Buenos Aires, Argentina, ¹²Sanatorio Finochietto, Buenos AIres, Ciudad Autonoma de Buenos Aires, Argentina, ¹³HIZGA "San Martin", La Plata, Buenos Aires, Argentina, ¹⁴Sanatorio Adventista del Plata, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁵Hospital Ramos Mejia, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina, ¹⁶Hospital Ramos Mejia, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁷CEMIC, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina, ¹⁸Hospital Provincial de Rosario, Rosario, Santa Fe, Argentina, ¹⁹Hospital San Martín, La Plata, Argentina, ²⁰Hospital San Martín. Instituto Médico Platense, La Plata

Meeting: 2019 ACR/ARP Annual Meeting

Keywords: axial spondyloarthritis and psoriatic arthritis, Spondylarthritis

Session Information

Date: Sunday, November 10, 2019

Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Axial Spondyloarthritis, Clinical Features

Session Type: Poster Session (Sunday)

Session Time: 9:00AM-11:00AM

Background/Purpose: Spondyloarthritis (Spa) is an heterogeneous group of diseases. Diagnostic delay contributes to poor patient outcome. Prompt diagnosis of Spa is the first step towards optimal patient management. The aims of the study were to determinate if there were difference in diagnostic delay of Spa before 2010 vs 2010-2019 and to identify features associated with diagnostic delay more than twelve months.

Methods: Cross-sectional, analytical, multi-center study. Patients older than 18 years, fulfilling ASAS criteria were inclued. Socio-demographic and clinical features, comorbidities and treatments were recorded. Disease activity: patient´s global assessment (GA), physician´s GA; peripheral: joint count (SJC66/TJC68), enthesis evaluation (LEI) and DAS28; axial: BASDAI, ASDAS-ERS, SASDAS-ERS, functional assessment by BASFI. Disability by HAQ; Quality of life by ASQol and global health status by ASAS Health Index. Statistical analysis: descriptive statistics, Mann-Whitney or T-test for continuous variables and Fisher’s exact test or Chi² for categorical ones, p 0.05 was considered significant. STATA 14.

Results: Two hundred one patients were inclued, 55.7% were males, mean age 48.8 years old (SD 14.3), median evolution time 65 months (IQR 24-132), median BMI 27.3 (IQR 22.7-35.8). More than half had peripheral involvement (53.73%). The 51.74% had enthesitis (n 101), 34.33% had dactylitis (n 69). Ninety-nine (49.5%) had psoriatic arthritis, 4.98% (n 10) inflammatory bowel disease and 13.93% (n 28) uveitis. Before 2010: diagnostic delay was longer than after 2010 [median 48 months (IQR 12-84) vs 12 months (IQR 4-24) p 0.000]. The greater diagnostic delay was associated to older patients [56 years old (IQR 42-64) vs 47 years old (34-56) p 0.001] and more of them loosed their job (p: 0.001). Diagnostic delay more than twelve months were associated with more prevalence of hypertension [39.3% vs 18.06% p: 0.003], loss of work [43.82 vs 23.61% p: 0.006] and use of biologics [58.43% vs 28.89% p: 0.010]. We did not find differences in disease activity, disability, quality of life or global health status by ASAS Health Index between both groups.

Conclusion: In recent years we have considerably improved the diagnosis delay of Spa. Even twelve months’ delay was associated with loss of work, more comorbidities (hypertension) and greater use of biological treatments. ASAS criteria and the best knowledge of our diseases have contributed to this improvement.

Disclosure: S. Scarafia, None; M. Girard Bosch, None; M. Benegas, None; V. Cosentino, None; J. Marin, None; V. Duarte, None; J. Bande, None; M. Gamba, None; F. Sommerfleck, None; P. Gonzalez, None; D. Vila, None; M. Oliver, None; M. Piovesan, None; R. Aguila, None; V. Edson Javier, None; E. Kerzberg, None; M. Tapia Moreira, None; M. Cosatti, None; C. Airoldi, None; M. Garcia, None; M. Martire, None.

To cite this abstract in AMA style:

Scarafia S, Girard Bosch M, Benegas M, Cosentino V, Marin J, Duarte V, Bande J, Gamba M, Sommerfleck F, Gonzalez P, Vila D, Oliver M, Piovesan M, Aguila R, Edson Javier V, Kerzberg E, Tapia Moreira M, Cosatti M, Airoldi C, Garcia M, Martire M. Diagnostic Delay in Spondyloarthritis [abstract]. Arthritis Rheumatol. 2019; 71 (suppl 10). https://acrabstracts.org/abstract/diagnostic-delay-in-spondyloarthritis/. Accessed .

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