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Diagnosis delay in patients with ankylosing spondylitis: possible reasons and proposals for new diagnostic criteria

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Ankylosing spondylitis (AS) is a chronic, progressive, and disabling disease. Among the rheumatological diseases, the longest diagnosis delay is still found for AS. The aim of this cross-sectional study is to evaluate the diagnosis delay and possible reasons in AS. A secondary aim is to assess the relation between diagnosis delay and some clinical and laboratory features. One hundred eleven AS patients, (103 male, 8 female) were recruited. A face-to-face interview was applied to take medical history, and a questionnaire that contains some clinical aspects of disease was used. Diagnosis delay was described as the gap between first spondiloarthropathic symptom and correct diagnosis of AS. The average of diagnosis delay was 6.05 ± 5.08 years. The average age of patients at disease onset was 23.18 ± 9.59, the average disease duration was 10.44 ± 8.11, and the average age at diagnosis was 27.88 ± 11.63. The average diagnosis delay was 5. 3 ± 3.5 in HLA B 27+ AS patients, whereas it was 9.2 ± 7.7 in HLA B 27 AS patients (p = 0.037). Diagnosis delay in patients with inflammatory back pain (+) (IBP) at disease onset was lower than IBP (−) patients (3.28 ± 3.32, 8.57 ± 8.54; respectively) (p = 0.001). The patients having positive family history had lower diagnosis delay than those with negative family history (4.60 ± 4.44, 10.00 ± 2.30; respectively) (p = 0.003). The diagnosis delay is a challenge and an important problem for patients with AS and physicians. HLA B27 and family history should be considered while making new criteria. Inflammatory back pain should be emphasized as the main screening criterion for primary care physicians. These clinical and laboratory features had positive effect on the average diagnosis delay in AS patients. Describing new diagnostic criteria, which is more useful to diagnosis of AS, is necessary.

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  1. Underwood MR, Dawes P (1995) Inflammatory back pain in primary care. Br J Rheumatol 34:1074–1077

    Article  PubMed  CAS  Google Scholar 

  2. van der Linden S, Valkenburg HA, Cats A (1984) Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 27:361–368

    Article  PubMed  Google Scholar 

  3. Mau W, Zeidler H, Mau R et al (1988) Clinical features and prognosis of patients with possible ankylosing spondylitis. Results of a 10-year followup. J Rheumatol 15:1109–1114

    PubMed  CAS  Google Scholar 

  4. Khan MA (2002) Update on spondyloarthropathies. Ann Intern Med 136:896–907

    PubMed  Google Scholar 

  5. Braun J, Sieper J, Breban M et al (2002) Anti-tumour necrosis factor alpha therapy for ankylosing spondylitis: international experience. Ann Rheum Dis 61(Suppl 3):iii51–iii60

    PubMed  CAS  Google Scholar 

  6. Van der Linden S, Valkenburg HA, de Jongh BM et al (1984) The risk of developing ankylosing spondylitis in HLA-B27 positive individuals: a comparison of relatives of spondylitis patients with the general population. Arthritis Rheum 27:241–249

    Article  PubMed  Google Scholar 

  7. Gran JT, Husby G, Hordvik M (1985) Prevalence of ankylosing spondylitis in males and females in a young middle-aged population in Tromsø, northern Norway. Ann Rheum Dis 44:359–367

    Article  PubMed  CAS  Google Scholar 

  8. Braun J, Bollow M, Remlinger G et al (1998) Prevalence of spondylarthropathies in HLA-B27 positive and negative blood donors. Arthritis Rheum 41:58–67

    Article  PubMed  CAS  Google Scholar 

  9. Sieper J, Braun J, Rudwaleit M, Boonen A, Zink A (2002) Ankylosing spondylitis: an overview. Ann Rheum Dis 61(Suppl 3):iii8–iii18

    PubMed  Google Scholar 

  10. Feldtkeller E, Khan MA, van der Heijde D et al (2003) Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatol Int 23:61–66

    PubMed  Google Scholar 

  11. Rudwaleit M, Khan MA, Sieper J (2005) The challenge of diagnosis and classification in early ankylosing spondylitis: do we need new criteria? Arthritis Rheum 52:1000–1008

    Article  PubMed  Google Scholar 

  12. Boyer GS, Templin DW, Bowler A et al (1977) A comparison of patients with spondyloarthropathy seen in specialty clinics with those identified in a communitywide epidemiologic study. Has the classic case misled us? Arch Intern Med 157:2111–2117

    Article  Google Scholar 

  13. O’Shea F, Salonen D, Inman R (2007) The challenge of early diagnosis in ankylosing spondylitis. J Rheumatol 34(1):5–7 (Jan)

    PubMed  Google Scholar 

  14. van der Heijde D, Dijkmans B, Geusens P et al (2005) Efficacy and safety of infliximab in patients with ankylosing spondylitis: results of a randomized, placebo-controlled trial (ASSERT). Arthritis Rheum 52:582–591

    Article  PubMed  CAS  Google Scholar 

  15. Davis JC, van der Heijde DM, Braun J et al (2005) Sustained durability and tolerability of etanercept in ankylosing spondylitis for 96 weeks. Ann Rheum Dis 64:1557–1562

    Article  PubMed  CAS  Google Scholar 

  16. van der Heijde D, Kivitz A, Schiff MH et al (2006) Efficacy and safety of adalimumab in patients with ankylosing spondylitis: results of a multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Rheum 2136–2146

  17. Rudwaleit M, Listing J, Brandt J et al (2004) Prediction of a major clinical response (BASDAI 50) to tumour necrosis factor alpha blockers in ankylosing spondylitis. Ann Rheum Dis 63:665–670

    Article  PubMed  CAS  Google Scholar 

  18. Mau W, Zeidler H, Mau R et al (1990) Evaluation of early diagnostic criteria for ankylosing spondylitis in a 10 year follow-up. Z Rheumatol 49:82–87

    PubMed  CAS  Google Scholar 

  19. Elyan M, Khan MA (2006) Diagnosing ankylosing spondylitis. J Rheumatol Suppl 78:12–23

    PubMed  Google Scholar 

  20. Calin A, Elswood J, Rigg S et al (1988) Ankylosing spondylitis—an analytical review of 1500 patients: the changing pattern of disease. J Rheumatol 15:1234–1238

    PubMed  CAS  Google Scholar 

  21. Calin A, Porta J, Fries JF et al (1977) Clinical history as a screening test for ankylosing spondylitis. JAMA 237(24):2613–2614 (Jun)

    Article  PubMed  CAS  Google Scholar 

  22. Rudwaleit M, van der Heijde D, Khan MA et al (2004) How to diagnose axial spondyloarthritis early. Ann Rheum Dis 63(5):535–543 (May)

    Article  PubMed  CAS  Google Scholar 

  23. Rudwaleit M, Metter A, Listing J et al (2006) Inflammatory back pain in ankylosing spondylitis: a reassessment of the clinical history for application as classification and diagnostic criteria. Arthritis Rheum 54(2):569–578

    Article  PubMed  Google Scholar 

  24. Hamersma J, Cardon LR, Bradbury L et al (2001) Is disease severity in ankylosing spondylitis genetically determined? Arthritis Rheum 44(6):1396–1400

    Article  PubMed  CAS  Google Scholar 

  25. Brown MA, Laval SH, Brophy S et al (2000) Recurrence risk modelling of the genetic susceptibility to ankylosing spondylitis. Ann Rheum Dis 59(11):883–886

    Article  PubMed  CAS  Google Scholar 

  26. Chou CT, Lu SJ, Lu P et al (1988) Family study of ankylosing spondylitis. J Formosan Med Assoc 87:989–999

    CAS  Google Scholar 

  27. Jimenez-Balderas FJ, Zonana-Nacach A, Sanchez ML, Talavera JO, Barile-Fabris L, Perez-Rodriguez ME, Arelano J, Fraga A (2003) Maternal age and family history are risk factors for ankylosing spondylitis. J Rheumatol 30(10):2182–2185

    Google Scholar 

  28. Sieper J, Rudwaleit M (2005) Early referral recommendations for ankylosing spondylitis (including pre-radiographic and radiographic forms) in primary care. Ann Rheum Dis 64(5):659–663

    Article  PubMed  CAS  Google Scholar 

  29. van Tubergen A, Heuft-Dorenbosch L, Schulpen G, Landewe R, Wijers R, van der Heijde D, van Engelshoven J, van der Linden S (2003) Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality? Ann Rheum Dis 62(6):519–525

    Article  PubMed  Google Scholar 

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Dincer, U., Cakar, E., Kiralp, M.Z. et al. Diagnosis delay in patients with ankylosing spondylitis: possible reasons and proposals for new diagnostic criteria. Clin Rheumatol 27, 457–462 (2008).

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