RT Journal Article
SR Electronic
T1 Initial Diagnosis of Lumbar Disc Herniation Is Associated with a Delay in Diagnosis of Ankylosing Spondylitis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.120106
DO 10.3899/jrheum.120106
A1 Vedat Gerdan
A1 Servet Akar
A1 Dilek Solmaz
A1 Yavuz Pehlivan
A1 Ahmet Mesut  Onat
A1 Bunyamin Kisacik
A1 Mehmet Sayarlioglu
A1 Cigdem Erhan
A1 Mehmet Engin  Tezcan
A1 Mehmet Akif  Ozturk
A1 Fatos Onen
A1 Nurullah Akkoc
YR 2012
UL http://www.jrheum.org/content/early/2012/07/26/jrheum.120106.abstract
AB Objective There is often a considerable delay in diagnosis of ankylosing spondylitis (AS). In this multicenter study, we analyzed the delay and possible associated factors, including an initial diagnosis of lumbar disc herniation (LDH), which we frequently encounter in daily clinical practice. Methods The study included 393 consecutive patients [258 men (65.6%), mean age 39.3 ± 10.8 yrs] with AS according to the modified New York criteria. Face-to-face interviews were done using a structured questionnaire, addressing all the potentially relevant factors. Results The mean diagnostic delay was 8.1 ± 8.6 years in the whole study population. The shortest delay was observed when rheumatologists were the first physicians consulted (2.9 ± 5.3 yrs). An initial diagnosis of LDH was reported by 33% of the patients. The diagnostic delays in patients with an initial diagnosis of LDH and those without were 9.1 ± 8.5 years and 6.2 ± 7.4 years, respectively (p = 0.002). In a regression model, predictive factors for delay in diagnosis were age at onset of spondyloarthritic symptoms, back pain, education level, prior diagnosis of LDH, and surgical history for LDH. Conclusion These results indicate the need to increase awareness of the concept of axial spondyloarthritis among specialists who might be the first physicians consulted by patients with AS for their back pain. There is also a need to develop strategies for early referral of such patients to rheumatologists.