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      Real-World Patient Experience on the Path to Diagnosis of Ankylosing Spondylitis

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          Abstract

          Introduction

          We describe the journey to diagnosis of ankylosing spondylitis (AS) from the patient perspective and examine differences in this journey by sex.

          Methods

          US adults aged ≥ 18 years with a self-reported AS diagnosis were recruited online through CreakyJoints, a patient support community, and ArthritisPower, a patient research registry. Respondents completed a web-based survey on sociodemographics, disease burden, and diagnosis history. Results were stratified by sex and time to diagnosis using two-sample t tests and χ 2 tests, respectively, to observe differences across the groups; P < 0.05 was considered statistically significant.

          Results

          Among 235 respondents, 174 (74.0%) were female. Mean (SD) ages of female and male respondents were 48.6 (10.6) and 53.1 (10.3) years, respectively. From the time respondents began seeking medical attention, 87 were diagnosed within ≤ 1 year, 71 in 2–9 years, and 77 after ≥ 10 years. Symptoms that led respondents to seek treatment were back pain (73.2%) and joint pain (63.8%); fatigue and difficulty sleeping were more common among respondents with longer times to diagnosis. During the diagnosis process, men with AS tended to receive quicker AS diagnosis compared with women. Overall, commonly reported initial diagnoses among respondents with longer time to AS diagnosis included back problems and psychosomatic disorders. Significantly more women reported misdiagnoses of fibromyalgia (20.7 vs. 6.6%) and psychosomatic disorders (40.8 vs. 23.0%) compared with men.

          Conclusions

          Diagnosis delays and misdiagnoses were common among respondents with AS. Increasing awareness about AS among referring providers may minimize diagnosis delay.

          Funding

          Novartis Pharmaceuticals Corporation.

          Plain Language Summary

          Plain language summary available for this article.

          Electronic Supplementary Material

          The online version of this article (10.1007/s40744-019-0153-7) contains supplementary material, which is available to authorized users.

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          Most cited references37

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          Sexual Dimorphism in the Th17 Signature of Ankylosing Spondylitis.

          To identify an immunologic basis for the male sex bias in ankylosing spondylitis (AS).
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            Prevalence of axial spondylarthritis in the United States: estimates from a cross-sectional survey.

            The US national prevalence of spondylarthritis (SpA) was estimated for 2 published sets of classification criteria: the Amor criteria and the European Spondylarthropathy Study Group (ESSG) criteria. These 2 SpA criteria sets have been the most widely utilized in previous population-based studies of SpA.
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              Is Open Access

              Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry

              Background/purpose Early diagnosis of inflammatory rheumatic diseases is important in order to improve long-term outcome. We studied whether delay in diagnosis (time between onset of symptoms and establishment of diagnosis) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PSA) and ankylosing spondylitis (AS) changed from year 2000 to 2011. Methods Month and year of initial symptoms and diagnosis, gender, hospital, year of birth and date of first data entry were obtained for 13 721 patients with RA, PSA or AS who had been registered in the DANBIO registry. Time between symptom onset and diagnosis was modelled using generalised linear regression to predict the average duration for each calendar year of initial symptoms with adjustments for gender, year of birth and date of DANBIO entry. Results Patients with valid data (RA: 10 416 (73%); PSA: 1970 (68%); AS: 1335 (65%)) did not differ significantly from the whole DANBIO population, except more missing data in early years. The regression model showed that the mean duration from initial symptoms to diagnosis for RA, PSA and AS declined steadily from 30, 53 and 66 months (year 2000), respectively, to 3–4 months (year 2011). Sensitivity analyses including patients who were included after 2005, patients who had received biological treatment or had symptom onset less than 2 and 5 years prior to first entry into DANBIO showed similar results. Conclusion Since the year 2000, a significant reduction in diagnostic delay was observed in this large cohort of patients with RA, PSA or AS, probably reflecting a stronger awareness of the importance of early diagnosis.
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                Author and article information

                Contributors
                alexis.ogdie@uphs.upenn.edu
                Journal
                Rheumatol Ther
                Rheumatol Ther
                Rheumatology and Therapy
                Springer Healthcare (Cheshire )
                2198-6576
                2198-6584
                30 April 2019
                30 April 2019
                June 2019
                : 6
                : 2
                : 255-267
                Affiliations
                [1 ]ISNI 0000 0004 1936 8972, GRID grid.25879.31, Perelman School of Medicine, , University of Pennsylvania, ; Philadelphia, PA USA
                [2 ]GRID grid.468156.8, Global Healthy Living Foundation, ; Upper Nyack, NY USA
                [3 ]GRID grid.492736.d, ICON, ; Gaithersburg, MD USA
                [4 ]ISNI 0000 0004 0439 2056, GRID grid.418424.f, Novartis Pharmaceuticals Corporation, ; East Hanover, NJ USA
                Article
                153
                10.1007/s40744-019-0153-7
                6513959
                31041666
                32452913-a3c4-4d45-b4e0-347511b86226
                © The Author(s) 2019
                History
                : 14 March 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/100008272, Novartis Pharmaceuticals Corporation;
                Award ID: N/A
                Categories
                Original Research
                Custom metadata
                © The Author(s) 2019

                ankylosing spondylitis,diagnosis,misdiagnosis,patient experience,real-world study

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