Delays in Axial Spondyloarthritis Diagnosis Persist
A new patient survey published in Rheumatology, conducted by the National Axial Spondyloarthritis Society (NASS), has revealed that the average time to diagnosis (TTD) for axial spondyloarthritis (axSpA) in the UK remains 8.29 years, with the longest delay occurring in primary care. The findings underscore the need for more efficient referral pathways to expedite diagnosis and improve patient outcomes.
The survey included 534 patients diagnosed with axSpA since January 2021. Analysis of the diagnostic timeline showed that the time from the first general practitioner (GP) visit to rheumatology referral accounted for 53% of the total diagnostic delay, with an average wait of 4.33 years.
Other key delays in the pathway included:
- 2.49 years (31%) from symptom onset to first GP visit
- 0.39 years (5%) waiting for the first rheumatology appointment following referral
- 0.88 years (11%) from initial rheumatology appointment to formal diagnosis
The study highlights that patients frequently see multiple health care providers before diagnosis, with 66% consulting physiotherapists and 63% seeing GPs repeatedly. Chiropractors (19%) and osteopaths (17%) also played a role in patient care prior to referral.
"The average time from first GP appointment to rheumatology referral was the longest wait, at 4.33 years (53% of the total delay)," the study reported. This finding suggests that improving early recognition of axSpA symptoms in primary care is critical for reducing diagnostic delays.
The survey also found that specialist axSpA clinics provide faster diagnoses due to greater expertise, access to musculoskeletal radiology, and expedited triage. However, these clinics are not available everywhere, limiting their impact on the broader axSpA population.
"Patients in these settings get a swifter diagnosis due to increased expertise, greater access to colocated MSK radiology services, and expedited triage out of general rheumatology pools," the study noted.
These findings emphasize the urgent need for targeted interventions in primary care, including improved clinician awareness, faster referral pathways, and expanded access to specialized services. Addressing these delays could reduce disease burden, minimize structural damage, and improve long-term outcomes for patients with axSpA.
Reference
Eddison J, Bamford S, Chan A, et al. P001 The patient journey to diagnosis for axial spondyloarthritis - the challenges in primary care and the positive impact of specialist axial SpA services. Lara D Veeken. 2024;63(Supplement_2). doi:10.1093/rheumatology/keae590.004
