Nordin Fatimah Zanirah, Shaharir Syahrul Sazliyana, Mohamed Said Mohd Shahrir, Mohd Rozita, Sakthiswary Rajalingham, Tengku Mohd Tengku Amatullah Madeehah, Jaafar Mohd Hafiz, Yew Wong Chin
Department of Internal Medicine, Faculty of Medicine and Health Sciences, Islamic Science University of Malaysia, Nilai, Malaysia.
Rheumatology Unit, Department of Internal Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Lupus. 2024 Dec;33(14):1645-1653. doi: 10.1177/09612033241297548. Epub 2024 Nov 7.
Heterogeneity of the clinical manifestations of systemic lupus erythematosus (SLE) may lead to diagnostic delays. This study is aimed at determining the health-seeking behaviour patterns and factors associated with diagnostic delays in a multi-ethnic SLE cohort in Malaysia.
This was a cross-sectional study involving SLE patients who visited our institute between January 2020 and June 2021. A review of the medical records and face-to-face interviews were conducted to obtain sociodemographics, SLE disease characteristics and the intervals from the first symptoms to the diagnosis. Health-seeking behaviours were assessed by asking about the patients' first action during the initial symptoms and were divided into: (i) seeking professional health personnel; (ii) self-treatment; and (iii) the use of the internet as a primary source of information. Diagnostic delays were defined as the interval between initial symptoms and SLE diagnosis of more than 6 months. Low-level disease activity state (LLDAS) at 12 months was assessed from the medical records. Univariate and multivariate logistic regression analysis was subsequently conducted to determine factors associated with diagnostic delays.
Among the 154 patients included in the study, 24% ( = 37) had delayed diagnosis. The delay was significantly higher among the Indian versus Malay versus Chinese (42.9% vs 28% vs 10.8%, = 0.037). Patients with rash tend to have delayed diagnosis (37.8% vs 22.2%, = 0.08) while fewer patients with frothy urine had delayed diagnosis (8.1% vs 21.4%, = 0.09). No significant association was found between health-seeking behaviours and diagnostic delays. The rate of LLDAS at 12 months was significantly lower among patients with delayed diagnosis (43.2% vs 70.0%, = 0.006). Chinese ethnicity remained the only significant factor associated with lesser diagnostic delays in the multivariate analysis, with OR 0.30 (CI 0.09-0.93), = 0.037.
There were ethnic disparities in the early diagnosis of SLE in Malaysia, with Indian patients having a longer interval between the first symptom and diagnosis while the Chinese were associated with lower diagnostic delays. Early diagnosis predicted early attainment of LLDAS, suggesting that prompt recognition of the initial SLE symptoms is important.
系统性红斑狼疮（SLE）临床表现的异质性可能导致诊断延迟。本研究旨在确定马来西亚一个多民族SLE队列中的就医行为模式以及与诊断延迟相关的因素。
这是一项横断面研究，纳入了2020年1月至2021年6月期间到我院就诊的SLE患者。通过查阅病历和面对面访谈来获取社会人口统计学信息、SLE疾病特征以及从首次出现症状到确诊的时间间隔。通过询问患者在出现初始症状时的首个行动来评估就医行为，分为：（i）寻求专业医护人员；（ii）自我治疗；（iii）将互联网作为主要信息来源。诊断延迟定义为初始症状与SLE确诊之间的间隔超过6个月。从病历中评估12个月时的低疾病活动状态（LLDAS）。随后进行单因素和多因素逻辑回归分析以确定与诊断延迟相关的因素。
在纳入研究的154例患者中，24%（n = 37）有诊断延迟。印度族患者的延迟诊断率显著高于马来族和华裔（42.9%对28%对10.8%，P = 0.037）。有皮疹的患者往往有诊断延迟（37.8%对22.2%，P = 0.08），而有泡沫尿的患者中诊断延迟的较少（8.1%对21.4%，P = 0.09）。未发现就医行为与诊断延迟之间存在显著关联。诊断延迟患者中12个月时的LLDAS发生率显著较低（43.2%对70.0%，P = 0.006）。在多因素分析中，华裔仍然是与诊断延迟较少相关的唯一显著因素，比值比为0.30（95%置信区间0.09 - 0.93），P = 0.037。
马来西亚SLE的早期诊断存在种族差异，印度族患者从首次出现症状到确诊的间隔时间更长，而华裔患者的诊断延迟较低。早期诊断预示着早期达到LLDAS，这表明及时识别SLE的初始症状很重要。
