Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis

Abstract Background Delay to diagnosis in axial SpA (axSpA) is longer than many other rheumatic diseases. Prolonged delay associate with poorer outcomes, including functional impairment and quality of life. Our aims were describe global variation diagnosis, factors associated delay, compared PsA. Methods We searched MEDLINE, PubMed, Embase Web Science using a predefined protocol. Diagnostic was defined as years between the age at symptom onset diagnosis. pooled mean random effects inverse variance meta-analysis. examined variations estimates prespecified subgroup analyses sources heterogeneity meta-regression. Results A total 64 studies reported diagnostic axSpA patients. The 6.7 (95% CI 6.2, 7.2) high levels heterogeneity. did not improve over time when stratifying results by year publication. Studies from high-income countries (defined World Bank) delays those middle-income countries. Factors consistently be lower education levels, younger absence extra-articular manifestations (EAMs). estimate for 8 PsA significantly shorter, 2.6 1.6, 3.6). Conclusion For patients, remains unacceptably prolonged parts world. Patient (e.g. education) disease presentation (onset EAMs) should inform campaigns delay.