Bandinelli Francesca, Martinelli-Consumi Bianca, Manetti Mirko, Vallecoccia Maria Sole
Rheumatology Department, Usl Tuscany Center, San Giovanni di Dio Hospital, 50143 Florence, Italy.
Section of Anatomy and Histology, Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
J Pers Med. 2024 Jan 13;14(1):91. doi: 10.3390/jpm14010091.
Diagnostic delay (DD) is associated with poor radiological and quality of life outcomes in axial spondyloarthritis (ax-SpA) and ankylosing spondylitis (AS). The female (F) population is often misdiagnosed, as classification criteria were previously studied mostly in males (M). We conducted a systematic review to investigate (i) the difference in DD between the sexes, the impact of HLAB27 and clinical and social factors (work and education) on this gap, and (ii) the possible influence of the year of publication (before and after the 2009 ASAS classification criteria), geographical region (Europe and Israel vs. extra-European countries), sample sources (mono-center vs. multi-center studies), and world bank (WB) economic class on DD in both sexes. We searched, in PubMed and Embase, studies that reported the mean or median DD or the statistical difference in DD between sexes, adding a manual search. Starting from 399 publications, we selected 26 studies (17 from PubMed and Embase, 9 from manual search) that were successively evaluated with the modified Newcastle-Ottawa Scale (m-NOS). The mean DD of 16 high-quality (m-NOS > 4/8) studies, pooled with random-effects meta-analysis, produces results higher in F (1.48, 95% CI 0.83-2.14, < 0.0001) but with significant results at the second analysis only in articles published before the 2009 ASAS classification criteria (0.95, 95% CI 0.05-1.85, < 0.0001) and in extra-European countries (3.16, 95% CI 2.11-4.22, < 0.05). With limited evidence, some studies suggest that DD in F might be positively influenced by HLAB27 positivity, peripheral involvement, and social factors.
诊断延迟（DD）与中轴型脊柱关节炎（ax-SpA）和强直性脊柱炎（AS）的不良放射学结果及生活质量相关。女性群体常被误诊，因为分类标准此前大多在男性中进行研究。我们开展了一项系统评价，以调查（i）性别间DD的差异、HLAB27以及临床和社会因素（工作和教育）对这一差距的影响，以及（ii）发表年份（2009年ASAS分类标准前后）、地理区域（欧洲和以色列与欧洲以外国家）、样本来源（单中心与多中心研究）和世界银行（WB）经济类别对两性DD的可能影响。我们在PubMed和Embase中检索报告了平均或中位数DD或性别间DD统计差异的研究，并进行了手工检索。从399篇出版物开始，我们选择了26项研究（17项来自PubMed和Embase，9项来自手工检索），随后用改良的纽卡斯尔-渥太华量表（m-NOS）进行评估。16项高质量（m-NOS>4/8）研究的平均DD，采用随机效应荟萃分析进行汇总，结果显示女性的DD更高（1.48，95%CI 0.83 - 2.14，<0.0001），但仅在2009年ASAS分类标准之前发表的文章（0.95，95%CI 0.05 - 1.85，<0.0001）和欧洲以外国家（3.16，95%CI 2.11 - 4.22，<0.05）的二次分析中有显著结果。证据有限，一些研究表明女性的DD可能受到HLAB27阳性、外周受累和社会因素的正向影响。
