Delayed diagnosis in axial spondyloarthritis —how can we do better?

The wide-reaching benefits of prompt diagnosis and treatment have long been demonstrated in RA [1,2]. A ‘window of opportunity’ for treatment initiation is reflected in clinical guidelines and drives efforts to reduce iagnostic delay, for example by establishing early arthritis services. Although international guidelines have advocated prompt referral and treatment initiation in axial spondyloarth ritis (axSpA) [3], this approach has been severely hampered by a number of unique challenges. A recent systematic review and metanalysis undertaken by Zhao and colleagues confirms a mean delay of 6.7  years, which did not improve when results were stratified by year of publication [4]. There is considerable evidence that an earlier diagnosis provides better outcomes for axSpA patients. A recent systematic review showed that longer delay to diagnosis was consistently associated with higher disease activity, poorer physical function, heightened anxiety and depression, and greater healthcare costs [5]. Delay is also linked to radiographic damage, which may reflect disease progression in the absence of prompt treatment. Evidence from observational studies has shown that TNF inhibitors reduce radiographic progression in AS [6], and apost hoc analysis of C ‐axSpAnd, the placebo controlled trial of certolizumab pegol in non-radiographic axSpA, demonstrated that patients with longer symptom duration have a significantly reduced response to TNF inhibitors; this is true both for the...

Source: Rheumatology - July 9, 2021 Category: Rheumatology Source Type: research