Understanding How the Diagnostic Delay of Spondyloarthritis Differs Between Women and Men: A Systematic Review and Metaanalysis
- 15 December 2016
- journal article
- research article
- Published by The Journal of Rheumatology in The Journal of Rheumatology
- Vol. 44 (2), 174-183
- https://doi.org/10.3899/jrheum.160825
Abstract
Objective.To identify empirical evidence of diagnostic delay in spondyloarthritis (SpA), determine whether sex-related differences persist, and conduct an analysis from that perspective of the possible causes, including the influence of quality research, in this group of inflammatory rheumatic diseases.Methods.A systematic review was done of delay in diagnosis of SpA in MEDLINE and EMBASE and other sources. Study quality was determined in line with the Strengthening The Reporting of OBservational studies in Epidemiology (STROBE) statement. A metaanalysis of 13 papers reporting sex-disaggregated data was performed to evaluate sex-related differences in diagnostic delay. The global effect of diagnostic delay by sex was calculated using means difference (D) through a fixed effects model.Results.The review included 23,883 patients (32.3% women) from 42 papers. No significant differences between the sexes were detected for symptoms at disease onset or during evolution. However, the mean for delay in diagnosis of SpA showed sex-related differences, being 8.8 years (7.4–10.1) for women and 6.5 (5.6–7.4) for men (p = 0.01). Only 40% of papers had high quality. A metaanalysis included 12,073 participants (31.2% women). The mean global effect was D = 0.6 years (0.31–0.89), indicating that men were diagnosed 0.6 year (7 months) before women.Conclusion.Delay in diagnosis of SpA persists, and is longer in women than in men. There are no significant sex-related differences in symptoms that could explain sex-related differences in diagnostic delay. Methodological and possible publication bias could result in sex-biased medical practice.This publication has 39 references indexed in Scilit:
- Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registryAnnals Of The Rheumatic Diseases, 2014
- Work Disability in Patients with Ankylosing Spondylitis in NorwayThe Journal of Rheumatology, 2011
- Predictors of radiographic severity and functional disability in Turkish patients with ankylosing spondylitisClinical Rheumatology, 2011
- Clinical characteristics of patients with ankylosing spondylitis in IndiaClinical Rheumatology, 2009
- Pattern of ankylosing spondylitis in an Iranian population of 98 patientsModern Rheumatology, 2009
- Women with ankylosing spondylitis: A reviewArthritis Care & Research, 2008
- Factors influencing health status and disability of patients with ankylosing spondylitis in the Czech RepublicClinical Rheumatology, 2008
- A framework to analyse gender bias in epidemiological researchJournal of Epidemiology and Community Health, 2007
- Ankylosing spondylitis in rochester, minnesota, 1935–1989. Is the epidemiology changing?Arthritis & Rheumatism, 1992
- Clinical diagnosis of ankylosing spondylitis in women and relation to presence of HLA-B27.Annals Of The Rheumatic Diseases, 1976