title: Ankylosing spondylitis in iran; late diagnosis and its causes.
abstract: BACKGROUND
  Ankylosing spondylitis (AS) is a chronic destructive and inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine.
  
  
  OBJECTIVE
  The aim of the present cross-sectional study was to evaluate and identify factors leading to delayed diagnosis of AS in Iranian patients.
  
  
  METHODS
  Sixty patients, (53 males, 7 females) with a diagnosis of AS according to the modified New York criteria were recruited. Diagnosis delay was defined as the interval between a patient's first spondyloarthritic symptoms [inflammatory back pain (IBP), inflammatory arthritis, enthesopathy and uveitis] and a correct diagnosis of AS.
  
  
  RESULTS
  The average age of patients at diagnosis of AS was 36.4 ± 4.5 years and the average of delay in diagnosis was 6.2 ± 3.5 years. The most common diagnosis at the first visit was disc herniation (68.3%). Delay in diagnosis of Human Leukocyte Antigen (HLA-B27) positive and negative patients were 4.6 ± 2.2 years and 10.1 ± 3.2 years, respectively (P = 0.0001). Diagnosis delay in patients with morning stiffness and IBP were significantly shorter than that of patients without these symptoms (P = 0.0001 and P = 0.001, respectively). Patients with uveitis had the shortest diagnosis delay (P = 0.02). The Bath Ankylosing spondylitis disease activity index (BASDAI) was not significantly different in early (< 3years) and late (> 3years) diagnosis (3.3 ± 0.9 and 3.6 ± 0.7, respectively) (P = 0.18), but the Both ankylosing spondylitis functional index (BASFI) was significantly different between them (3.3 ± 1.0 and 4.1 ± 0.7 respectively) (P = 0.001).
  
  
  CONCLUSIONS
  In this study, delay in diagnosis was similar to other studies. Educating physicians to careful history taking especially in the case of IBP, non-musculoskeletal symptoms such as uveitis and precise physical examination are important in early diagnosis.
authors.affiliation: Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Mehrzad
authors.initials: M
authors.lastname: Hajialilo
authors.affiliation: Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Amir
authors.initials: A
authors.lastname: Ghorbanihaghjo
authors.affiliation: Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Khabbazi
authors.affiliation: Connective Tissue Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Suosan
authors.initials: S
authors.lastname: Kolahi
authors.affiliation: Drug Applied Research Center, Tabriz University of Medical Sciences, Tabriz, IR Iran.
authors.forename: Nadereh
authors.initials: N
authors.lastname: Rashtchizadeh
keywords: Back Pain; Delayed Diagnosis; Spondylitis, Ankylosing