Delayed Diagnosis of nr-axSpA

Transcript: Sergio Schwartzman, MD: Phil, maybe you can summarize this next question. In terms of the delay in diagnosis of nonradiographic axial spondyloarthritis, how long is that delay? Also, independent of other physicians seeing the patient before a rheumatologist, why do you think there may be a delay?

Philip J. Mease, MD: Tiffany has given us an eloquent exposition about this. Just listening to her story, we understand. We heard the way in which she bounced around from clinician to clinician, even among different rheumatologists, and was given a variety of diagnoses along the way. This is classic for this patient group. We’ve touched on many of the reasons already. Now we know that it’s equigender, but historically it was thought to be a male-dominant disease, so there is a bias against making the diagnosis in women by nonrheumatologists and rheumatologists alike.

Nonradiographic axial spondyloarthritis is underdiagnosed because some of the nuances of making the diagnosis—as so eloquently described by Atul—you need to put together pieces of a jigsaw puzzle, and sometimes you can get false negatives and positives on the MRI [magnetic resonance imaging] scan or the CRP [C-reactive protein]. So I think we’ve covered it. It used to be that the classic ankylosing spondylitis literature showed that it was 10 years for women and 6 years for men. I mentioned that earlier.

In recent studies, that number has come down fortunately. One of the most recent studies I’ve seen is that it takes 4 years on average in women, which is matching Tiffany’s experience, and about 2 years in men. That is suggesting increased sensitivity on the part of rheumatologists. But then there are all these people out there in the wilderness, so to speak, who aren’t getting to rheumatologists. That’s where a lot of the link of diagnosis is remaining.

Sergio Schwartzman, MD: It’s interesting. If you look at some of the European registries for nonradiographic axial spondyloarthritis—Maxime Dougados’s registry, for example—they have from symptom onset to time of diagnosis. In those European studies, it’s 2 to 3 years. I think that number is shrinking, as long as you’re sent to the right place.

Philip J. Mease, MD: Yes.

Transcript Edited for Clarity