Improvement of Delayed Diagnosis of Ankylosing Spondylitis in a Chinese Population
Delayed diagnosis remains a significant challenge in the management of ankylosing spondylitis (AS), a primary phenotype of axial spondyloarthritis (ax-SpA). Over the years, advancements in diagnostic criteria, particularly the 2009 Assessment of SpondyloArthritis International Society (ASAS) criteria, have introduced more effective methods for early detection, such as the use of MRI. Despite these improvements, there is limited evidence on whether diagnostic delays have been reduced in China. This study aims to address this gap by comparing two datasets collected over a 14-year period from the same hospital to evaluate changes in diagnostic timelines and identify contributing factors.
The study enrolled 566 patients, including 212 from the 2006 cohort and 354 from the 2020 cohort. The majority of participants were male (81.3%), and most were under 30 years old at the time of correct diagnosis (71.7%). Patients were divided into subgroups based on the timing of their correct diagnosis—before and after 2009—and further categorized by age groups, particularly focusing on those under 40 years old. The analysis revealed no significant difference in the age composition of correctly diagnosed patients between the two cohorts. However, there was a notable increase in the proportion of female patients diagnosed after 2009 (P = 0.003).
The study utilized WeChat questionnaires, which demonstrated a higher response rate (96.5%) compared to traditional telephone call-backs (91.3%). This shift towards electronic data collection highlights the potential for more efficient and reliable data gathering methods in scientific research.
Significant improvements in diagnostic delays were observed over the 15-year period. The average time from the onset of symptoms to correct diagnosis decreased from 4.5 years to 1.1 years. This reduction was particularly pronounced in the 20 to 24 and 25 to 29 age groups, where the delay times became more concentrated in a narrower range, indicating a more efficient diagnostic process post-2009. The study found no significant gender differences in diagnostic delays among individuals aged 20 to 30 years, suggesting that the improvements benefited both male and female patients equally.
Several factors likely contributed to these improvements. Increased awareness among physicians and the general population, the adoption of the 2009 ASAS criteria, and the widespread use of MRI for early detection played crucial roles. Additionally, a better understanding of AS and the increased availability of X-rays also likely contributed to reducing diagnostic delays. While the study did not specifically analyze whether the reduced delays were due to MRI scans, the proactive use of this diagnostic tool at the study center supports its potential impact.
The study also noted an increase in the proportion of female patients diagnosed after 2009, rising from 14.3% to 24.6%. This shift may be attributed to the emphasis on MRI in the new diagnostic criteria, which helped identify female patients with atypical symptoms who might have been overlooked previously. Early detection and management are particularly beneficial for female patients, as they tend to have higher ASAS Health Index scores than men.
This retrospective study, conducted at the largest rheumatic immune center in South China, provides valuable insights into the impact of the 2009 ASAS criteria on diagnostic delays. The center’s involvement in the development of these criteria ensured a rigorous and professional application, enhancing the reliability of the findings. However, the study acknowledges certain limitations, such as the potential influence of patient subjectivity and recall bias in questionnaire responses. Future research aims to explore additional factors, such as the impact of HLA-B27 testing and the timing of initial radiological examinations, to further understand the dynamics of diagnostic delays.
In conclusion, the application of the 2009 ASAS criteria has significantly improved the timeliness of AS diagnosis in China over the past 14 years. The strategic use of MRI and increased awareness among healthcare providers have been pivotal in reducing diagnostic delays, particularly among younger patients. Continued efforts to refine diagnostic processes and address potential biases will be essential in further improving patient outcomes.
doi.org/10.1097/CM9.0000000000001950
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