Understanding the barriers, facilitators and extent of diagnostic delay in axial spondyloarthritis

Hay, Charles Andrew

Abstract

Background: Axial spondyloarthritis (axSpA) causes inflammation of the pelvis and spine, resulting in chronic pain, impaired range of movement, fatigue and physical disability. Diagnosis remains challenging and is frequently delayed, resulting in poorer outcomes for patients.

Aim: To ascertain the extent of diagnostic delay for axSpA, to explore patient and healthcare professionals (HCP) perspectives on barriers and facilitators in diagnosing axSpA and to study primary care consultation histories prior to diagnosis.

Method: Mixed-methods design. A systematic review examined the extent of aXSpA diagnostic delay and the role of certain characteristics on delay. A qualitative study explored patient and HCP knowledge and experience of barriers and facilitators in diagnosing axSpA using semi-structured one-to-one interviews and thematic analysis. A case-control study compared the type and frequency of primary care consultations histories of patients with axSpA to those of matched controls.

Results: The systematic review found median diagnostic delay to range from 2-5 years. Gender and family history of axSpA, despite affecting disease presentation, were not associated with delay.
Qualitative study found that patients and HCPs felt that communication, symptoms and behaviour of patients, difficulties in diagnosing axSpA, lack of awareness of axSpA and systemic issues with healthcare impeded diagnosis. The case-control study found that patients who subsequently are diagnosed with axSpA consult more than those who don’t have axSpA. AxSpA patients are more likely to consult with axial and peripheral symptoms, uveitis, enthesitis, inflammatory bowel disease and psoriasis prior to diagnosis.

Conclusion: Diagnostic delay in axSpA remains extensive and multicausal. This thesis highlights factor currently impeding diagnosis, along with possible solutions including disease education and improving the means and process of communication between patients and HCPs. This thesis suggests several symptoms which can be viewed as indicators of potential axSpA which could reduce diagnostic delay.

Citation

Hay, C. A. Understanding the barriers, facilitators and extent of diagnostic delay in axial spondyloarthritis. (Thesis). Keele University. https://keele-repository.worktribe.com/output/775300

• Thesis Type: Thesis
• Deposit Date: Mar 14, 2024
• Publicly Available Date: Mar 14, 2024
• Public URL: https://keele-repository.worktribe.com/output/775300
• Award Date: 2024-03