Yi Esther, Ahuja Amit, Rajput Tanvi, George Aneesh Thomas, Park Yujin
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
Novartis Healthcare Pvt Ltd., Hyderabad, India.
Rheumatol Ther. 2020 Mar;7(1):65-87. doi: 10.1007/s40744-020-00194-8. Epub 2020 Jan 21.
Few studies have evaluated the impact of delayed diagnosis of axial spondyloarthritis (axSpA) on the overall burden of disease. The objective of this review was to evaluate the available literature on the clinical, economic, and humanistic burden of delayed diagnosis in patients with axSpA.
This systematic literature review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the MEDLINE and Embase databases for English-language publications of original research articles (up to July 12, 2018) and conference abstracts (January 1, 2014, to July 12, 2018) reporting studies of adult patients with delayed diagnosis of axSpA associated with clinical, economic, or humanistic burden. Retrieved publications were screened for eligibility by two independent reviewers; discrepancies were resolved by a third independent reviewer. Data were extracted by one reviewer and validated by a second independent reviewer.
A total of 1391 publications were retrieved, of which 21 met the inclusion criteria and were included in the analysis. Of these, 15 reported data on clinical burden, nine on economic burden, and six on humanistic burden, with eight studies reporting a combination of clinical, economic, and/or humanistic burden. Patients with a delayed diagnosis of axSpA generally had higher disease activity, worse physical function, and more structural damage than those who received an earlier diagnosis. Patients with a delayed diagnosis also had a greater likelihood of work disability and higher direct and indirect healthcare costs than those who received an earlier diagnosis. Delayed diagnosis was associated with a greater likelihood for depression, negative psychological impacts, and worse quality of life.
Delayed axSpA diagnosis was associated with more functional impairment, higher healthcare costs, and worse quality of life, highlighting the importance of early recognition of axSpA to reduce extensive burden on patients and society. Plain language summary available for this article.
很少有研究评估轴性脊柱关节炎（axSpA）延迟诊断对疾病总体负担的影响。本综述的目的是评估关于axSpA患者延迟诊断的临床、经济和人文负担的现有文献。
本系统文献综述按照系统评价和Meta分析的首选报告项目指南进行实施和报告。我们在MEDLINE和Embase数据库中检索了关于成人axSpA延迟诊断与临床、经济或人文负担相关研究的英文原创研究文章（截至2018年7月12日）和会议摘要（2014年1月1日至2018年7月12日）。由两名独立评审员对检索到的出版物进行资格筛选；分歧由第三名独立评审员解决。数据由一名评审员提取，并由第二名独立评审员进行验证。
共检索到1391篇出版物，其中21篇符合纳入标准并纳入分析。其中，15篇报告了临床负担数据，9篇报告了经济负担数据，6篇报告了人文负担数据，8项研究报告了临床、经济和/或人文负担的综合情况。axSpA延迟诊断的患者通常比早期诊断的患者具有更高的疾病活动度、更差的身体功能和更多的结构损伤。延迟诊断的患者比早期诊断的患者工作残疾的可能性更大，直接和间接医疗费用更高。延迟诊断与抑郁、负面心理影响的可能性更大以及生活质量更差相关。
axSpA延迟诊断与更多的功能障碍、更高的医疗费用和更差的生活质量相关，凸显了早期识别axSpA以减轻患者和社会广泛负担的重要性。本文提供通俗易懂的总结。
