Ankylosing spondylitis in Iran : late diagnosis and its causes

الملخص EN

Background : Ankylosing spondylitis (AS) is a chronic destructive and inflammatory disease of the axial skeleton manifested by back pain and progressive stiffness of the spine.

Objectives : The aim of the present cross-sectional study was to evaluate and identify factors leading to delayed diagnosis of AS in Iranian patients.

Patients and Methods : Sixty patients, (53 males, 7 females) with a diagnosis of AS according to the modified New York criteria were recruited.

Diagnosis delay was defined as the interval between a patient’s first spondyloarthritic symptoms [inflammatory back pain (IBP), inflammatory arthritis, enthesopathy and uveitis] and a correct diagnosis of AS.

Results : The average age of patients at diagnosis of AS was 36.4 ± 4.5 years and the average of delay in diagnosis was 6.2 ± 3.5 years.

The most common diagnosis at the first visit was disc herniation (68.3 %).

Delay in diagnosis of Human Leukocyte Antigen (HLA-B27) positive and negative patients were 4.6 ± 2.2 years and 10.1 ± 3.2 years, respectively (P = 0.0001).

Diagnosis delay in patients with morning stiffness and IBP were significantly shorter than that of patients without these symptoms (P = 0.0001 and P = 0.001, respectively).

Patients with uveitis had the shortest diagnosis delay (P = 0.02).

The Bath Ankylosing spondylitis disease activity index (BASDAI) was not significantly different in early ( < 3years) and late ( > 3years) diagnosis (3.3 ± 0.9 and 3.6 ± 0.7, respectively) (P = 0.18), but the Both ankylosing spondylitis functional index (BASFI) was significantly different between them (3.3 ± 1.0 and 4.1 ± 0.7 respectively) (P = 0.001).

Conclusions : In this study, delay in diagnosis was similar to other studies.

Educating physicians to careful history taking especially in the case of IBP, non-musculoskeletal symptoms such as uveitis and precise physical examination are important in early diagnosis.