Michelena, X, Zhao, SS, Marco-Pascual, C et al. (10 more authors) (2023) Diagnostic delay is associated with uveitis and inflammatory bowel disease in AS: a study of extra-musculoskeletal manifestations in SpA. Rheumatology. kead225. ISSN 1462-0324
Abstract
Objectives
To examine the prevalence of extra-musculoskeletal manifestations (EMM) and the association between diagnostic delay and their incidence in ankylosing spondylitis (AS) and psoriatic arthritis (PsA).
Methods
Retrospective, cohort study comprising two single centre cohorts in Europe and one multicentre cohort in Latin America (RESPONDIA). EMMs (uveitis, inflammatory bowel disease [IBD] and psoriasis) crude prevalence was calculated across geographic area and adjusted by direct standardisation. Cox proportional hazard analysis were performed to assess the association between diagnostic delay and EMM incidence.
Results
Of 3553 patients, 2097 had AS and 1456 had PsA. The overall prevalence of uveitis was 22.9% (95%CI 21.1–24.8) in AS and 3.8% (95%CI 2.9–5.0) in PsA; 8.1% (95%CI 7.0–9.4) and 2.1% (1.3–2.9) respectively for IBD; 11.0% (95%CI 9.7–12.4) and 94.6% (93.0–95.9) for psoriasis; with EMM often presenting before the arthritis (uveitis 45.1% and 33.3%; IBD 37.4% and 70% in AS and PsA respectively). In the multivariable model, longer diagnostic delay (≥5 years) associated with more uveitis (HR 4.01, 95%CI 3.23–4.07) and IBD events (HR 1.85, 95%CI 1.28–2.67) in AS. Diagnostic delay was not significantly associated with uveitis (HR 1.57, 95%CI 0.69–3.59) or IBD events (HR 1.59, 95%CI 0.39–6.37) in PsA.
Conclusion
EMMs are more prevalent in AS than PsA and often present before the onset of the articular disease. A longer diagnostic delay is associated with the “de novo” appearance of uveitis and IBD in AS, highlighting the need to enhance diagnostic strategies to shorten the time from first symptom to diagnosis in SpA.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © The Author(s) 2023. This is an author produced version of an article published in Rheumatology. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Ankylosing spondylitis, psoriatic arthritis, psoriasis, uveitis, inflammatory bowel disease, diagnostic delay |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Discovery & Translational Science Dept (Leeds) |
Funding Information: | Funder Grant number NIHR National Inst Health Research NIHR202395 |
Depositing User: | Symplectic Publications |
Date Deposited: | 01 Jun 2023 15:06 |
Last Modified: | 15 May 2024 00:13 |
Status: | Published online |
Publisher: | Oxford University Press |
Identification Number: | 10.1093/rheumatology/kead225 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:199801 |