Abstract：
OBJECTIVE: To delineate the landscape of diagnostic delay in Chinese axial spondyloarthritis (axSpA), investigate its associated factors, and explore its potential impact on medication modalities.
METHODS: A total of 1295 patients fulfilling the ASAS classification criteria were obtained. Demographic and clinical data were collected through face-to-face interviews, based on predesigned questionnaires and available medical records. Logistic regression analyses under univariate and multivariable model were performed, using the median of diagnostic delay as the cut-off point for group classification. Differences between early- and late-diagnosed groups were subsequently compared by the Pearson chi-square test or Mann-Whitney U test.
RESULTS: Of 1295 axSpA patients, 80.3% were male and the median of disease duration was 8.0 years. The median (IQR) diagnostic delay in Chinese axSpA was 3.0 (1.0 ~ 7.0) years and 24.8% of them reported a history of misdiagnosis. Older age at onset (OR = 0.97, p < .001) and higher education attainment (p = .001) were correlated with early diagnosis of axSpA, whereas coming from less developed areas (p = .002), a history of peripheral arthritis at the time of diagnosis (OR = 1.58, p = .002) and history of misdiagnosis (OR = 1.98, p < .001) increased the risk of diagnostic delay. Oral medication modalities were similar between two groups, but the proportion with no medication ever was higher in the late-diagnosed group (26.5% vs. 20.7%, p = .02).
CONCLUSIONS: Our findings depicted a detailed spectrum of diagnostic delay in Chinese axSpA, verified five associated factors that may help facilitate timely diagnosis of axSpA, and pinpointed that timely medication was unsatisfying, especially in the late diagnosis group.
METHODS: A total of 1295 patients fulfilling the ASAS classification criteria were obtained. Demographic and clinical data were collected through face-to-face interviews, based on predesigned questionnaires and available medical records. Logistic regression analyses under univariate and multivariable model were performed, using the median of diagnostic delay as the cut-off point for group classification. Differences between early- and late-diagnosed groups were subsequently compared by the Pearson chi-square test or Mann-Whitney U test.
RESULTS: Of 1295 axSpA patients, 80.3% were male and the median of disease duration was 8.0 years. The median (IQR) diagnostic delay in Chinese axSpA was 3.0 (1.0 ~ 7.0) years and 24.8% of them reported a history of misdiagnosis. Older age at onset (OR = 0.97, p < .001) and higher education attainment (p = .001) were correlated with early diagnosis of axSpA, whereas coming from less developed areas (p = .002), a history of peripheral arthritis at the time of diagnosis (OR = 1.58, p = .002) and history of misdiagnosis (OR = 1.98, p < .001) increased the risk of diagnostic delay. Oral medication modalities were similar between two groups, but the proportion with no medication ever was higher in the late-diagnosed group (26.5% vs. 20.7%, p = .02).
CONCLUSIONS: Our findings depicted a detailed spectrum of diagnostic delay in Chinese axSpA, verified five associated factors that may help facilitate timely diagnosis of axSpA, and pinpointed that timely medication was unsatisfying, especially in the late diagnosis group.
摘要：
目的：描述中国轴性脊柱关节炎（axSpA）的诊断延迟情况，调查其相关因素，并探讨其对用药方式的潜在影响。
方法：共获得1295名符合ASAS分类标准的患者。通过面对面访谈收集人口统计学和临床数据，根据预先设计的问卷和可用的医疗记录。在单变量和多变量模型下进行Logistic回归分析，使用诊断延迟的中位数作为组分类的截止点。随后通过Pearson卡方检验或Mann-WhitneyU检验比较早期和晚期诊断组之间的差异。
结果：在1295名axSpA患者中，80.3%为男性，病程中位数为8.0年。中国axSpA的诊断延迟中位数（IQR）为3.0（1.0〜7.0）年，其中24.8％报告有误诊史。发病年龄较大（OR=0.97，p<.001）和受教育程度较高（p=.001）与axSpA的早期诊断相关，而来自欠发达地区(p=0.002)，诊断时的外周关节炎病史(OR=1.58,p=.002)和误诊病史(OR=1.98,p<.001)增加了诊断延迟的风险.两组口服药物治疗方式相似，但在晚期诊断组中，没有药物治疗的比例更高(26.5%vs.20.7%,p=.02）。
结论：我们的发现描绘了中国axSpA诊断延迟的详细频谱，验证了可能有助于及时诊断axSpA的五个相关因素，并指出及时用药并不令人满意，尤其是晚期诊断组。
方法：共获得1295名符合ASAS分类标准的患者。通过面对面访谈收集人口统计学和临床数据，根据预先设计的问卷和可用的医疗记录。在单变量和多变量模型下进行Logistic回归分析，使用诊断延迟的中位数作为组分类的截止点。随后通过Pearson卡方检验或Mann-WhitneyU检验比较早期和晚期诊断组之间的差异。
结果：在1295名axSpA患者中，80.3%为男性，病程中位数为8.0年。中国axSpA的诊断延迟中位数（IQR）为3.0（1.0〜7.0）年，其中24.8％报告有误诊史。发病年龄较大（OR=0.97，p<.001）和受教育程度较高（p=.001）与axSpA的早期诊断相关，而来自欠发达地区(p=0.002)，诊断时的外周关节炎病史(OR=1.58,p=.002)和误诊病史(OR=1.98,p<.001)增加了诊断延迟的风险.两组口服药物治疗方式相似，但在晚期诊断组中，没有药物治疗的比例更高(26.5%vs.20.7%,p=.02）。
结论：我们的发现描绘了中国axSpA诊断延迟的详细频谱，验证了可能有助于及时诊断axSpA的五个相关因素，并指出及时用药并不令人满意，尤其是晚期诊断组。
