Department of Clinical Immunology and Rheumatology, St. John's Medical College Hospital, Bengaluru, India.
Department of Clinical Immunology and Rheumatology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Dehradun, India.
Lupus. 2024 Nov;33(13):1416-1423. doi: 10.1177/09612033241283111. Epub 2024 Sep 10.
Systemic Lupus Erythematosus (SLE) warrants an early diagnosis and prompt management. Delay in diagnosis can result in repeated flares, permanent damage, and even death. There is a large variability in the time taken to diagnose SLE across the world. We undertook this study to determine the time taken for diagnosis of SLE in India and to identify the factors associated.
Patients with SLE diagnosed within the previous 1 year as per Systemic Lupus Erythematosus International Collaborating Clinics criteria (SLICC) 2012 criteria were included in a cross-sectional multicentre questionnaire-based survey. Demographic profile, self-reported socioeconomic status as per Kuppuswamy classification of socioeconomic status (version 2022) (SES), and several healthcare related parameters including referral pattern were recorded. Median time taken for diagnosis was used to demarcate early or late diagnosis and associated factors were explored.
We included 488 patients with SLE from 10 rheumatology centres. The median time to diagnosis was 6 months Interquartile Range (IQR 3,14.7) and within 3 months in about one third [150(30.7%)]. Very early diagnosis (1 month) was established in 78(16.0%) patients. The mean SLE Disease Activity Index (SLEDAI) at diagnosis was 10.287.24. In univariate analysis, an older age, lower SES, non-southern state of residence and larger family size were significantly associated with late diagnosis. In the multivariate analysis, higher SES (AOR 0.95, 95% CI: 0.92-0.98), multiple organ system involvement at initial presentation (AOR1.75 95%CI: 1.08-2.84) and place of residence in south Indian states (AOR1.92 95%CI: 1.24-2.97) had lesser odds of being associated with late diagnosis. Distance from the closest medical centre/professional did not influence the time to diagnosis. Majority of patients had first consulted a medical graduate (42.5%) or postgraduate doctor (48.2%), and referral to rheumatologist was largely done by postgraduate (65%) doctors. More than half of our patients (61%) self-finance their treatment.
Median time to diagnosis of SLE was 6 months, 1/3rd being diagnosed within 3 months and 78(16.0%) with 1 month of symptom onset. Delay in diagnosis was noted in those belonging to lower socioeconomic strata and those with single organ disease. Distance to the health care facility did not influence time to diagnosis.
系统性红斑狼疮（SLE）需要早期诊断和及时治疗。诊断延迟会导致病情反复、永久性损伤，甚至死亡。全球诊断 SLE 的时间差异很大。我们进行这项研究是为了确定印度诊断 SLE 所需的时间，并确定相关因素。
我们纳入了在过去 1 年内根据 2012 年系统性红斑狼疮国际协作临床标准（SLICC）确诊的 SLE 患者，进行了一项横断面多中心基于问卷的调查。记录了人口统计学特征、根据库普斯瓦米社会经济地位分类（2022 年版）（SES）自评的社会经济地位（SES），以及包括转诊模式在内的多项医疗相关参数。使用中位诊断时间来划分早期或晚期诊断，并探讨相关因素。
我们纳入了来自 10 个风湿病中心的 488 例 SLE 患者。中位诊断时间为 6 个月（IQR 3,14.7），约三分之一的患者在 3 个月内[150（30.7%）]确诊。78 例（16.0%）患者在 1 个月内得到了非常早期的诊断。诊断时平均 SLE 疾病活动指数（SLEDAI）为 10.287.24。单因素分析显示，年龄较大、SES 较低、非南部州居住和家庭规模较大与晚期诊断显著相关。多因素分析显示，SES 较高（AOR 0.95，95%CI：0.92-0.98）、初诊时多器官系统受累（AOR1.75，95%CI：1.08-2.84）和居住在印度南部州（AOR1.92，95%CI：1.24-2.97）的患者较少出现晚期诊断。与最近的医疗中心/专业人士的距离并不影响诊断时间。大多数患者首先咨询了医学毕业生（42.5%）或研究生医生（48.2%），而转诊给风湿病医生主要由研究生（65%）医生完成。我们超过一半的患者（61%）自费治疗。
SLE 的中位诊断时间为 6 个月，1/3 在 3 个月内确诊，78（16.0%）在症状出现后 1 个月内确诊。SES 较低和单器官疾病患者的诊断延迟。与医疗保健设施的距离并不影响诊断时间。
