title: Initial diagnosis of lumbar disc herniation is associated with a delay in diagnosis of ankylosing spondylitis.
abstract: OBJECTIVE
  There is often a considerable delay in diagnosis of ankylosing spondylitis (AS). In this multicenter study, we analyzed the delay and possible associated factors, including an initial diagnosis of lumbar disc herniation (LDH), which we frequently encounter in daily clinical practice.
  
  
  METHODS
  The study included 393 consecutive patients [258 men (65.6%), mean age 39.3 ± 10.8 yrs] with AS according to the modified New York criteria. Face-to-face interviews were done using a structured questionnaire, addressing all the potentially relevant factors.
  
  
  RESULTS
  The mean diagnostic delay was 8.1 ± 8.6 years in the whole study population. The shortest delay was observed when rheumatologists were the first physicians consulted (2.9 ± 5.3 yrs). An initial diagnosis of LDH was reported by 33% of the patients. The diagnostic delays in patients with an initial diagnosis of LDH and those without were 9.1 ± 8.5 years and 6.2 ± 7.4 years, respectively (p = 0.002). In a regression model, predictive factors for delay in diagnosis were age at onset of spondyloarthritic symptoms, back pain, education level, prior diagnosis of LDH, and surgical history for LDH.
  
  
  CONCLUSIONS
  These results indicate the need to increase awareness of the concept of axial spondyloarthritis among specialists who might be the first physicians consulted by patients with AS for their back pain. There is also a need to develop strategies for early referral of such patients to rheumatologists.
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
authors.forename: Vedat
authors.initials: V
authors.lastname: Gerdan
authors.forename: Servet
authors.initials: S
authors.lastname: Akar
authors.forename: Dilek
authors.initials: D
authors.lastname: Solmaz
authors.forename: Yavuz
authors.initials: Y
authors.lastname: Pehlivan
authors.forename: Ahmet Mesut
authors.initials: AM
authors.lastname: Onat
authors.forename: Bunyamin
authors.initials: B
authors.lastname: Kisacik
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sayarlioglu
authors.forename: Cigdem
authors.initials: C
authors.lastname: Erhan
authors.forename: Mehmet Engin
authors.initials: ME
authors.lastname: Tezcan
authors.forename: Mehmet Akif
authors.initials: MA
authors.lastname: Ozturk
authors.forename: Fatos
authors.initials: F
authors.lastname: Onen
authors.forename: Nurullah
authors.initials: N
authors.lastname: Akkoc
mesh_terms: D000328:Adult; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis*; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis*; D011795:Surveys and Questionnaires