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Diagnostic delay in AS, PsA, RA has decreased since 2000 in Denmark
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The time from symptom onset to diagnosis among patients with ankylosing spondylitis, psoriatic arthritis or rheumatoid arthritis declined between 2000 and 2011, according to analysis of the DANBIO registry in Denmark.
Researchers conducted an observation study of 13,721 patients with ankylosing spondylitis (AS), psoriatic arthritis (PsA) or rheumatoid arthritis (RA) from the DANBIO registry, a cohort assembled to study drug efficacy and safety.
The study included 10,416 patients with RA (73.2% women; mean age at entry: 58.9 years), 1,970 patients with PsA (56% women; mean age at entry: 48.8 years) and 1,335 patients with AS (29.1% women; mean age at entry: 40.8 years) and incorporated both patients newly diagnosed and those with longer disease duration.
Patients were followed prospectively, and treatment and disease activity data were collected regularly between January 2000 and December 2011. Potential confounders identified were patient age, geographic location, gender and year of entry into the registry and were adjusted with bivariate, general linear regression, Poisson distribution and other analyses.
During the entire study period, the average time to diagnosis among patients with RA from symptom onset was 23 months. In patients with PsA, time to diagnosis averaged 41 months, and patients with AS were diagnosed in 88 months, on average.
Between 2000 and 2002, the time to diagnosis for patients with RA was a mean of 24 months, compared with a mean of 6 months between 2009 and 2011. Patients with PsA were diagnosed in 42 months, on average, between 2000 and 2002 and in 7 months between 2009 and 2011. AS was diagnosed in a mean of 64 months between 2000 and 2002, and in an average of 10 months between 2009 and 2011.
Regression models showed that in all three diseases, only the calendar year of symptom onset influenced time to diagnosis significantly and independently from year of birth, year of study entry, gender or geographical region. However, year of birth was statistically significant in patients with RA, and gender had an effect on time-to-diagnosis in patients with PsA, according to the researchers. Four sensitivity analyses showed similar results. – by Shirley Pulawski
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Leonard H. Calabrese, DO
Rheumatologists congratulate yourselves! Sorenson and colleagues have presented some amazing data demonstrating that in Copenhagen, efforts for early diagnosis and assumedly access to care are working. In their comparison of the diagnostic lag time between symptoms and diagnosis from 2000 to 2011, the researchers found a dramatic drop from 24 months to 6 months for RA, from 42 months to 7 months for PsA, and from 64 months to 10 months for SpA.
While for each of these diseases it is likely that different reasons belie the data, they are nonetheless stunning. Perhaps from a technical perspective, SpA is easiest to grasp given recent classifications with emphasis on molecular testing and MRI. For psoriasis, we should also give our dermatology colleagues credit for new referral patterns and the introduction of new instruments for screening like the PASE tool and others. Lastly for RA, the entire field has been transformed with an emphasis on treat early and treat hard. It will be of great interest to see if these data will be replicated in other countries, such as the United States.
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