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Research article
Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis
Sizheng Zhao
University of Liverpool Institute of Ageing and Chronic Disease
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3558-7353
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. Delay to diagnosis in axial spondyloarthritis (axSpA) is longer than many other rheumatic diseases. Prolonged delay has been shown to associate with poorer outcomes including functional impairment and quality of life. Our aims were to describe 1) global variation in delay to diagnosis, 2) factors associated with delay, and 3) differences in diagnostic delay between axSpA and psoriatic arthritis (PsA).
Methods. We searched Medline, PubMed, EMBASE and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Delay to diagnosis was defined as years between age at symptom onset and age at diagnosis. We pooled mean diagnostic delay using random-effects inverse variance meta-analysis. We examined variations in pooled estimates using pre-specified subgroup analyses and sources of heterogeneity using meta-regression.
Results. A total of 64 studies reported mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% confidence interval 6.2 to 7.2) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delay than those from middle-income countries. Factors consistently reported to be associated with longer delay were: lower education levels, younger age at symptom onset and absence of extra-articular manifestations. Pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95%CI 1.6 to 3.6).
Conclusion. For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world, although some countries have reported remarkable improvements. Patient factors (education) and disease presentation (age at onset and extra-articular manifestations) should inform awareness campaigns to improve delay. Targets for improvement should aim to resemble delays in other spondyloarthritis patients.
Keywords
axial spondyloarthritis, ankylosing spondylitis, delay to diagnosis, psoriatic arthritis, meta-analysis
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Sizheng S Zhao
ORCiDcommented on 09 October, 2020
Note from the authors: This manuscript was withdrawn from Arthritis Research & Therapy and published in Rheumatology (Oxford) under the title "Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis". The authors will openly share reviewer comments and reasons for withdrawal upon request.
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CURRENT STATUS: Under Review
Version 2
Posted 04 Jun, 2020
Community comments: 1
Editor assigned
On 27 May, 2020
Submission checks complete
On 26 May, 2020
Editor invited
On 26 May, 2020
No comments provided
Editorial decision: Major revision
On 19 May, 2020
Review #3 received
Received 15 May, 2020
Review #4 received
Received 14 May, 2020
Reviewer #4 agreed
On 06 May, 2020
Reviewer #3 agreed
On 27 Apr, 2020
Review #2 received
Received 27 Apr, 2020
Reviewer #2 agreed
On 08 Apr, 2020
Reviewer #1 agreed
On 02 Apr, 2020
Review #1 received
Received 02 Apr, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
Editor assigned
On 16 Mar, 2020
Submission checks complete
On 15 Mar, 2020
Editor invited
On 15 Mar, 2020
First submitted
On 13 Mar, 2020
Metrics
Comments: 1
PDF Downloads: ...
HTML Views: ...
Subject Areas
Rheumatology
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This preprint is under consideration at Arthritis Research & Therapy. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Systematic review and meta-analysis of diagnostic delay in axial spondyloarthritis
Sizheng Zhao
University of Liverpool Institute of Ageing and Chronic Disease
Corresponding Author
ORCiD: https://orcid.org/0000-0002-3558-7353
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 2
Posted 04 Jun, 2020
Community comments: 1
Editor assigned
On 27 May, 2020
Submission checks complete
On 26 May, 2020
Editor invited
On 26 May, 2020
No comments provided
Editorial decision: Major revision
On 19 May, 2020
Review #3 received
Received 15 May, 2020
Review #4 received
Received 14 May, 2020
Reviewer #4 agreed
On 06 May, 2020
Reviewer #3 agreed
On 27 Apr, 2020
Review #2 received
Received 27 Apr, 2020
Reviewer #2 agreed
On 08 Apr, 2020
Reviewer #1 agreed
On 02 Apr, 2020
Review #1 received
Received 02 Apr, 2020
Reviewers invited
Invitations sent on 30 Mar, 2020
Editor assigned
On 16 Mar, 2020
Submission checks complete
On 15 Mar, 2020
Editor invited
On 15 Mar, 2020
First submitted
On 13 Mar, 2020
Metrics
Comments: 1
PDF Downloads: ...
HTML Views: ...
Subject Areas
Rheumatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background. Delay to diagnosis in axial spondyloarthritis (axSpA) is longer than many other rheumatic diseases. Prolonged delay has been shown to associate with poorer outcomes including functional impairment and quality of life. Our aims were to describe 1) global variation in delay to diagnosis, 2) factors associated with delay, and 3) differences in diagnostic delay between axSpA and psoriatic arthritis (PsA).
Methods. We searched Medline, PubMed, EMBASE and Web of Science using a predefined protocol in accordance with PRISMA guidelines. Delay to diagnosis was defined as years between age at symptom onset and age at diagnosis. We pooled mean diagnostic delay using random-effects inverse variance meta-analysis. We examined variations in pooled estimates using pre-specified subgroup analyses and sources of heterogeneity using meta-regression.
Results. A total of 64 studies reported mean diagnostic delay in axSpA patients. The pooled mean delay was 6.7 years (95% confidence interval 6.2 to 7.2) with high levels of heterogeneity. Delay to diagnosis did not improve over time when stratifying results by year of publication. Studies from high-income countries (defined by the World Bank) reported longer delay than those from middle-income countries. Factors consistently reported to be associated with longer delay were: lower education levels, younger age at symptom onset and absence of extra-articular manifestations. Pooled estimate for diagnostic delay from 8 PsA studies was significantly shorter, at 2.6 years (95%CI 1.6 to 3.6).
Conclusion. For axSpA patients, delay to diagnosis remains unacceptably prolonged in many parts of the world, although some countries have reported remarkable improvements. Patient factors (education) and disease presentation (age at onset and extra-articular manifestations) should inform awareness campaigns to improve delay. Targets for improvement should aim to resemble delays in other spondyloarthritis patients.
Figure 1
Figure 2
Sizheng S Zhao
ORCiDcommented on 09 October, 2020
Note from the authors: This manuscript was withdrawn from Arthritis Research & Therapy and published in Rheumatology (Oxford) under the title "Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis". The authors will openly share reviewer comments and reasons for withdrawal upon request.