AB0925 PATIENTS’ PERSPECTIVE ON DIAGNOSTIC DELAYS IN SPONDYLOARTHROPATHIES IN POLAND
Authors: A. Felis-Giemza, M. Stajszczyk, B. Kwiatkowska, M. Lewicki, M. Tombarkiewicz
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Despite the relevant progress in imaging techniques, physicians education, including primary care physicians, and patient education, there is still a problem of late diagnosis of inflammatory spondyloarthropathies and, therefore, implementation of effective treatment [1]. Misdiagnoses at the onset of symptoms may be one of the reasons for delayed diagnosis in these patients [2]. <h3>Objectives:</h3> This study aimed to assess the time from the first symptoms to diagnosis in patients with non-radiographic spondyloatriopathy (nrSpA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) and to identify the causes of diagnosis delays from the patients' perspective. <h3>Methods:</h3> A total of 165 patients were invited to complete the survey, of which 130 patients from two rheumatology centers providing biological treatment for patients with nrSpA, AS and PsA took part in the study. The study was conducted using the CAWI (Computer-Assisted Web Interview) technique between September and December 2022 and included 49 patients with nrSpA, 43 with AS and 38 with PsA. <h3>Results:</h3> Overall, for the entire study group, the diagnostic delay was on average 6.7 years (median 4.2). The average time from the first symptoms to the correct diagnosis was 7.4 years in patients with nrSpA (median 3.5), 7.5 years (median 6.0) in AS and 5.5 (median 2.6) years in PsA. In most patients, rheumatologist was the physician who initially suspected the disease (47%) and made the final diagnosis (96%). The physicians with whom the patient initially consulted the symptoms were most often a family physician, an orthopedist, a neurologist and a dermatologist. Before proper diagnosis, approx.. 50% of patients were examined by physicians of two different specialties, 20% of patients by three, and 10% of patients by four. Initial misdiagnoses were made in 57% of patients with nrSpA, 53% with AS and 44% with PsA. The most common misdiagnoses of non-inflammatory diseases delaying the diagnosis of spondyloathropathies were joint/spine overload pain (30%-32%), discopathy (10%-32%), osteoarthritis (25%-30%), psoriasis (4%-40%), gout (4%-10%) and primary gastroenterological and ophthalmological diseases (4%-10%). Moreover, Lyme disease was frequently diagnosed in patients with PsA (30%) and Lyme disease and fibromyalgia in patients with nrSpA (14%). Overall, 23% of patients reported a misdiagnosis as the reason for the diagnostic delay, 20% pointed to a the doctor's incompetence, 14% to the doctor's dismissive approach to the patient's symptoms, and 13% to persistent symptomatic treatment. <h3>Conclusion:</h3> Diagnostic delays in spondyloathropathies in Poland are comparable to those in other countries, much longer in the case of patients with axial SpA than in patients with PsA. From the patients' perspective, misdiagnosis made at various stages of the disease course made by physicians other than rheumatologist is the most important factor delaying early proper diagnosis. <h3>REFERENCES:</h3> [1] Garrido-Cumbrera M, Poddubnyy D, Gossec L, Gálvez-Ruiz D, Bundy C, Mahapatra R, et al. The European map of axial spondyloarthritis: capturing the patient perspective-an analysis of 2846 patients across 13 countries. Curr Rheumatol Rep. 2019;21(1534-6307 (Electronic)):19. [2] Lapane K, Khan S, Shridharmurthy D, Beccia A, Dubé C, Yi E, et al. Primary care physician perspectives on barriers to diagnosing axial Spondyloarthritis: a qualitative study. BMC Fam Pract. 2020;21(1471-2296 (Electronic)):204. <h3>Acknowledgements:</h3> This study was funded by Novartis Poland Sp. z o.o. <h3>Disclosure of Interests:</h3> Anna Felis-Giemza AFG has speaking contracts with AbbVie, Biogen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sandoz, and UCB., AFG consults with AbbVie, Biogen, Eli Lilly, Janssen, Novartis, Pfizer, Roche, Sandoz, and UCB., Marcin Stajszczyk MS has speaking contracts with AbbVie, Amgen, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, Sandoz, Swedish Orphan Biovitrum AB, UCB., MS has speaking contracts, clinical trial contracts, and/or consults with AbbVie, Amgen, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, Sandoz, Swedish Orphan Biovitrum AB, UCB., Brygida Kwiatkowska BK has speaking contracts with AbbVie, Amgen, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, Sandoz, UCB., BK has speaking contracts, clinical trial contracts, and/or consults with AbbVie, Amgen, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Janssen, Merck Sharp &amp; Dohme, Novartis, Pfizer, Roche, Sandoz, UCB., Maciej Lewicki: None declared, Marek Tombarkiewicz: None declared.