Research Article
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Investigation of Delay in The Diagnosis of Ankylosing Spondylitis and Associated Factors on The Diagnosis Process

Year 2019, Volume: 13 Issue: 4, 487 - 499, 20.12.2019
https://doi.org/10.21763/tjfmpc.651510

Abstract

Aim: Since Ankylosing Spondylitis (AS) is an insidious disease, delays may occur in the diagnosis and treatment. This study aims to reveal the initial symptoms, determine the duration between initial symptoms and the time of diagnosis and associated socio-demographic factors. Methods: This cross-sectional study was conducted in the Department of Rheumatology, University of Health Sciences Gulhane Medical Faculty in April 2015 – June 2016. A survey with 25 questions prepared by the researchers was applied to 269 participants by face-to-face interview method. Results: The median duration of the delay time in diagnosis was 2 (0.08-16) years (mean; 3.28 ± 3.32) years. The current median age was 27 (19-70) years, the median age at onset of symptoms was 21 (4-64) years, and the median age at diagnosis was 24 (11-66) years. Statistically significant positive correlations were found between the delay time in diagnosis and the current age (r=0.195, p=0.001) and the age at diagnosis (r=0.247, p<0.001). However, the delay time in diagnosis was inversely correlated with the onset age of symptoms (r=-0.186, p=0.002). There was a significant association between the delay time in diagnosis and application to state hospitals (r=0.222, p<0.001), private hospitals (r=0.166, p=0.008). A significant correlation was detected between the delay time in diagnosis and applying to all the specialties except rheumatology. Conclusions: The delay in the diagnosis causes impairment in quality of life and labor loss. It also leads to unnecessary health expenditures and loss of time in diagnosis. The laboratory tests are not sufficient alone. Shortening the diagnostic process is important by carefully evaluating the information obtained from history and physical examination.

Amaç: Ankilozan Spondilit (AS) sinsi seyirli bir hastalık olduğundan, tanı ve tedavide gecikmeler olabilmektedir. Bu çalışmanın amacı, AS’li hastaların başlangıç semptomları, semptomların başlamasından tanı konulana kadar geçen sürenin saptanması, geç tanı konulmasını ile ilişkili sosyodemogrofik özelliklerin ortaya konmasıdır. Yöntem: Bu kesitsel çalışma Nisan 2015 – Haziran 2016 tarihleri arasında Gülhane Tıp Fakültesi Romatoloji Bilim Dalı’nda gerçekleştirilmiştir. Yüz yüze görüşme yöntemiyle uygulanan 25 soruluk anket formu 269 katılımcıya uygulanmıştır. Bulgular: Tanı gecikme süresi ortancası 2 (0,08-16) (ortalaması; 3,28±3,32) yıl bulunmuştur. Şimdiki yaş ortancası 27 (19-70) (ortalaması; 30±8,5) yaş, semptom başlama yaşı ortancası 21 (4-64) (ortalaması; 22,5±7,6) yaş, tanı konma yaşı ortancası 24 (11-66) (ortalaması; 25,6±7,7) yaş olarak saptanmıştır. Tanı gecikme süresi ile şimdiki yaş (r=0,195, p=0,001) ve tanı yaşı (r=0,247, p<0,001) arasında pozitif yönde istatistiksel olarak anlamlı bir korelasyon bulunmuştur. Tanı gecikme süresi ile semptom başlama yaşı(r= -0,186, p=0,002) ise ters ilişki bulunmuştur. Çalışmamızda tanı gecikme süresi ile devlet hastanesi (r=0,222, p<0,001) ve özel hastaneye (r=0,166, p=0,008) başvuru sıklığı arasında anlamlı ilişki tespit edilmiştir. Romatoloji dışında diğer uzmanlık dallarına başvuru ile tanı gecikme süreleri arasında anlamlı korelasyon saptanmıştır. Sonuç: Tanı koymada gecikme nedeni ile özellikle hastaların yaşam kalitesinde azalma ve iş gücünde kayıplar ortaya çıkmaktadır. Aynı zamanda bu durum sağlık hizmetlerinde gereksiz harcamalara ve tanı konulma sürecinde zaman kaybına yol açmaktadır. Yapılan tetkikler tek başına yeterli olmamaktadır. Öykü ve fizik muayeneden elde edilen bilgilerin dikkatli şekilde değerlendirilerek tanı sürecini kısaltmak önem arz etmektedir.

References

  • 1. Gran JT, Husby G. Epidemiology of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (Eds.). Third edition Rheumatology vol. 2. Edinburg: Mosby, Elsevier Limited; 2003, p.1153-9.
  • 2. Khan MA. Clinical features of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Winblatt ME, Weisman MH (eds). Rheumatology. Edinburgh: Mosby, 2003: 1161-82.
  • 3. Calin A, Porta J, Fries JF, Schurman DJ. Clinical history as a screening test for ankylosing spondylitis. JAMA 1977; 237: 2613-4.
  • 4. Sheehan NJ, Slavin BM, Donovan MP, Mount JN, Mathews JA. Lack of correlation between clinical disease activity and erythrocyte sedimentation rate, acute phase proteins or protease inhibitors in ankylosing spondylitis. Br J Rheumatol 1986; 25: 171-4.
  • 5. Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H , et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999; 26: 980-4.
  • 6. Davis JC. Ankylosing spondylitis. In: Koopman WJ, Moreland LW (eds). Arthritis and Allied Conditions. Philadelphia: LWW, 2005:1319-34.
  • 7. Gerdan V, Akar S, Solmaz D, Pehlivan Y, Onat AM, Kisacik B , et al. Initial diagnosis of lumbar disc herniation is associated with a delay in diagnosis of ankylosing spondylitis. J Rheumatol 2012; 39: 1996-9.
  • 8. Çaðlar NS, Burnaz Ö, Akýn T, Özgönenel L, Çetin E, Aytekin E , et al. Demographic and Clinical Properties and Medical Treatments of Patients Followed as Ankylosing Spondylitis. Ýstanbul Med J 2011; 12: 19-24.
  • 9. Hajialilo M, Ghorbanihaghjo A, Khabbazi A, Kolahi S, Rashtchizadeh N. Ankylosing spondylitis in iran; late diagnosis and its causes. Iran Red Crescent Med J 2014; 16: e11798.
  • 10. Seo MR, Baek HL, Yoon HH, Ryu HJ, Choi HJ, Baek HJ , et al. Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol 2015; 34: 1397-405.
  • 11. Nakashima Y, Ohishi M, Okazaki K, Fukushi J, Oyamada A, Hara D , et al. Delayed diagnosis of ankylosing spondylitis in a Japanese population. Mod Rheumatol 2016; 26: 421-5.
  • 12.Bandinelli F, Salvadorini G, Delle Sedie A, Riente L, Bombardieri S, Matucci-Cerinic M. Impact of gender, work, and clinical presentation on diagnostic delay in Italian patients with primary ankylosing spondylitis. Clin Rheumatol. 2016;35:473-8.
  • 13. Ogdie A, Benjamin Nowell W. Real-World Patient Experience on the Path to Diagnosis of Ankylosing Spondylitis. RheumatolTher. 2019; 6:255-67.
  • 14. Deodhar A, Mittal M, Reilly P, Bao Y, Manthena S, Anderson J, Joshi A. Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol. 2016;35:1769-76.
Year 2019, Volume: 13 Issue: 4, 487 - 499, 20.12.2019
https://doi.org/10.21763/tjfmpc.651510

Abstract

References

  • 1. Gran JT, Husby G. Epidemiology of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH (Eds.). Third edition Rheumatology vol. 2. Edinburg: Mosby, Elsevier Limited; 2003, p.1153-9.
  • 2. Khan MA. Clinical features of ankylosing spondylitis. In: Hochberg MC, Silman AJ, Smolen JS, Winblatt ME, Weisman MH (eds). Rheumatology. Edinburgh: Mosby, 2003: 1161-82.
  • 3. Calin A, Porta J, Fries JF, Schurman DJ. Clinical history as a screening test for ankylosing spondylitis. JAMA 1977; 237: 2613-4.
  • 4. Sheehan NJ, Slavin BM, Donovan MP, Mount JN, Mathews JA. Lack of correlation between clinical disease activity and erythrocyte sedimentation rate, acute phase proteins or protease inhibitors in ankylosing spondylitis. Br J Rheumatol 1986; 25: 171-4.
  • 5. Spoorenberg A, van der Heijde D, de Klerk E, Dougados M, de Vlam K, Mielants H , et al. Relative value of erythrocyte sedimentation rate and C-reactive protein in assessment of disease activity in ankylosing spondylitis. J Rheumatol 1999; 26: 980-4.
  • 6. Davis JC. Ankylosing spondylitis. In: Koopman WJ, Moreland LW (eds). Arthritis and Allied Conditions. Philadelphia: LWW, 2005:1319-34.
  • 7. Gerdan V, Akar S, Solmaz D, Pehlivan Y, Onat AM, Kisacik B , et al. Initial diagnosis of lumbar disc herniation is associated with a delay in diagnosis of ankylosing spondylitis. J Rheumatol 2012; 39: 1996-9.
  • 8. Çaðlar NS, Burnaz Ö, Akýn T, Özgönenel L, Çetin E, Aytekin E , et al. Demographic and Clinical Properties and Medical Treatments of Patients Followed as Ankylosing Spondylitis. Ýstanbul Med J 2011; 12: 19-24.
  • 9. Hajialilo M, Ghorbanihaghjo A, Khabbazi A, Kolahi S, Rashtchizadeh N. Ankylosing spondylitis in iran; late diagnosis and its causes. Iran Red Crescent Med J 2014; 16: e11798.
  • 10. Seo MR, Baek HL, Yoon HH, Ryu HJ, Choi HJ, Baek HJ , et al. Delayed diagnosis is linked to worse outcomes and unfavourable treatment responses in patients with axial spondyloarthritis. Clin Rheumatol 2015; 34: 1397-405.
  • 11. Nakashima Y, Ohishi M, Okazaki K, Fukushi J, Oyamada A, Hara D , et al. Delayed diagnosis of ankylosing spondylitis in a Japanese population. Mod Rheumatol 2016; 26: 421-5.
  • 12.Bandinelli F, Salvadorini G, Delle Sedie A, Riente L, Bombardieri S, Matucci-Cerinic M. Impact of gender, work, and clinical presentation on diagnostic delay in Italian patients with primary ankylosing spondylitis. Clin Rheumatol. 2016;35:473-8.
  • 13. Ogdie A, Benjamin Nowell W. Real-World Patient Experience on the Path to Diagnosis of Ankylosing Spondylitis. RheumatolTher. 2019; 6:255-67.
  • 14. Deodhar A, Mittal M, Reilly P, Bao Y, Manthena S, Anderson J, Joshi A. Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol. 2016;35:1769-76.
There are 14 citations in total.

Details

Primary Language English
Subjects ​Internal Diseases
Journal Section Orijinal Articles
Authors

Erkan Berke This is me

Ümit Aydoğan This is me

Yusuf Çetin Doğaner This is me

Sedat Yılmaz This is me

Publication Date December 20, 2019
Submission Date June 27, 2019
Published in Issue Year 2019 Volume: 13 Issue: 4

Cite

Vancouver Berke E, Aydoğan Ü, Doğaner YÇ, Yılmaz S. Investigation of Delay in The Diagnosis of Ankylosing Spondylitis and Associated Factors on The Diagnosis Process. TJFMPC. 2019;13(4):487-99.

English or Turkish manuscripts from authors with new knowledge to contribute to understanding and improving health and primary care are welcome.