title: Diagnostic delay in axial spondyloarthritis: A cross-sectional study of 432 patients.
abstract: OBJECTIVE
  The diagnostic delay of axial spondyloarthritis (axSpA) is usually reported to be more than seven years but may have decreased recently. The objective was to quantify the diagnostic delay in patients with axSpA in France and to explore its associated factors.
  
  
  METHODS
  Two cross-sectional observational studies included consecutively patients with axSpA (according to both ASAS criteria and rheumatologist expert opinion). Diagnostic delay was defined as the time interval from the date of first symptoms to the date of diagnosis. Potential predictive factors of diagnostic delay analyzed by multiple linear regression were demographic factors, HLA B27 status, year of diagnosis, clinical presentation and sacroiliitis on MRI or radiography.
  
  
  RESULTS
  In all, 432 patients were analyzed: the mean age at diagnosis was 34.2 (standard deviation, 12.5) years, the mean disease duration at the time of the assessment was 11.4 (10.4) years. In all, 66.7% were HLA B27 positive, and 70.2% had radiographic sacroiliitis. The mean diagnostic delay was 4.9 (6.3) years, with a median of 2.0 years (interquartile range, 1-7; range: 0-43). In multivariable analysis, factors independently associated with a longer diagnostic delay were: higher age at diagnosis (beta=0.13; P<0.001), less frequent peripheral arthritis or dactylitis (beta=-1.69; P=0.005), and more frequent entheseal pain (beta=1.46; P=0.015).
  
  
  CONCLUSIONS
  The median diagnostic delay was 2 years indicating diagnostic delay may be for most patients shorter than previously reported. A more "typical" SpA clinical presentation was associated with a shorter diagnostic delay, whereas sacroiliitis and HLA B27 positivity were not associated with this delay.
authors.affiliation: Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France; AP-HP, Paris Descartes University, Rheumatology, Cochin Hospital, 75014 Paris, France.
authors.forename: Vanina
authors.initials: V
authors.lastname: Masson Behar
authors.affiliation: AP-HP, Paris Descartes University, Rheumatology, Cochin Hospital, 75014 Paris, France.
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.affiliation: AP-HP, Paris Descartes University, Rheumatology, Cochin Hospital, 75014 Paris, France.
authors.forename: Adrien
authors.initials: A
authors.lastname: Etcheto
authors.affiliation: Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kreis
authors.affiliation: Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France; René-Dubos Hospital, 95300 Pontoise, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Fabre
authors.affiliation: AP-HP, Paris Descartes University, Rheumatology, Cochin Hospital, 75014 Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Hudry
authors.affiliation: Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Dadoun
authors.affiliation: Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France.
authors.forename: Christopher
authors.initials: C
authors.lastname: Rein
authors.affiliation: René-Dubos Hospital, 95300 Pontoise, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Pertuiset
authors.affiliation: Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
authors.affiliation: Sorbonne University, UPMC University Paris 06, GRC-08, Institut Pierre-Louis d'Épidémiologie et de Santé Publique, 75013 Paris, France; AP-HP, Pitié-Salpétrière Hospital, Rheumatology department, 75013 Paris, France. Electronic address: laure.gossec@aphp.fr.
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D025241:Spondylarthritis / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
keywords: Delay; Diagnosis; Spondyloarthritis