Time and patient journey to axial spondyloarthritis diagnosis: a retrospective study in French primary care.

Abstract

Axial spondyloarthritis (axSpA) diagnoses are often delayed, which is associated with poorer patient outcomes. To improve understanding of diagnostic delay in France, we describe the time and patient journey to axSpA diagnosis in primary care. This retrospective consecutive case series of adult axSpA patients in France (January 2000-August 2023) analysed primary care data from The Health Improvement Network® (THIN) database. Key study outcomes were time from earliest GP-recorded back pain diagnosis to axSpA diagnosis, and number and type of back pain episodes in this period. Other variables included axSpA symptoms and comorbidities at back pain and axSpA diagnosis, and healthcare resource utilization (HCRU). Of 7313 adult patients diagnosed with axSpA eligible for inclusion, 4402 had a prior back pain diagnosis. Mean time from earliest back pain to axSpA diagnosis was 6.3 years. Mean number of back pain episodes recorded prior to axSpA diagnosis was 6.1; 17.3% of patients experienced ≥10 episodes. Lower back pain was the most common (47.4% of diagnoses). The proportion of patients experiencing >1 axSpA symptom or comorbidity increased from 1.9% or 23.7% at earliest back pain diagnosis to 8.9% or 50.7% at axSpA diagnosis, respectively. HCRU was high; mean number of primary care consultations per patient per year between earliest back pain and axSpA diagnosis was 7.0. Patients in France wait over 6 years for an axSpA diagnosis. This research may raise awareness of the patient journey to axSpA diagnosis and support development of a primary care flagging strategy to identify patients with suspected axSpA earlier.