Masson Behar Vanina, Dougados Maxime, Etcheto Adrien, Kreis Sarah, Fabre Stéphanie, Hudry Christophe, Dadoun Sabrina, Rein Christopher, Pertuiset Edouard, Fautrel Bruno, Gossec Laure
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.
AP-HP, Paris Descartes University, Rheumatology, Cochin Hospital, 75014 Paris, France.
Joint Bone Spine. 2017 Jul;84(4):467-471. doi: 10.1016/j.jbspin.2016.06.005. Epub 2016 Jul 21.
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.
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.
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).
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.
轴性脊柱关节炎（axSpA）的诊断延迟通常报告超过7年，但近期可能有所减少。本研究旨在量化法国axSpA患者的诊断延迟情况，并探讨其相关因素。
两项横断面观察性研究连续纳入了符合axSpA诊断标准（依据ASAS标准及风湿病专家意见）的患者。诊断延迟定义为从首次出现症状至确诊的时间间隔。通过多元线性回归分析诊断延迟的潜在预测因素，包括人口统计学因素、HLA B27状态、诊断年份、临床表现以及MRI或X线片显示的骶髂关节炎。
共分析了432例患者：诊断时的平均年龄为34.2（标准差12.5）岁，评估时的平均病程为11.4（10.4）年。总体而言，66.7%的患者HLA B27呈阳性，70.2%的患者有骶髂关节X线片异常。平均诊断延迟为4.9（6.3）年，中位数为2.0年（四分位间距为1 - 7年；范围：0 - 43年）。多变量分析显示，与诊断延迟较长独立相关的因素包括：诊断时年龄较大（β = 0.13；P < 0.001）、外周关节炎或指（趾）炎发作频率较低（β = -1.69；P = 0.005）以及附着点疼痛发作频率较高（β = 1.46；P = 0.015）。
诊断延迟的中位数为2年，表明多数患者的诊断延迟可能比之前报告的要短。更“典型”的SpA临床表现与较短的诊断延迟相关，而骶髂关节炎及HLA B27阳性与该延迟无关。
