POS0670 DIAGNOSTIC DELAY IS ASSOCIATED WITH WORSE OUTCOMES IN TERMS OF STRUCTURAL DAMAGE IN PATIENTS WITH RADIOGRAPHIC AXIAL SPONDYLOARTHRITIS. RESULTS FROM REGISPONSER-AS

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 616
• Main Authors: Ladehesa Pineda, M L, M Á Puche Larrubia, Pilar, F U, A Escudero Contreras, E Collantes Estevez, López-Medina, C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Arthritis; Arthroplasty (hip); Dactylitis; Diagnosis; Disease; Histocompatibility antigen HLA; Inflammatory bowel disease; Inflammatory bowel diseases; Inflammatory diseases; Meta-analysis; Psoriasis; Quality of life; Regression analysis; Rheumatic diseases; Rheumatology; Sacroiliitis; Socioeconomic factors; Spine (lumbar); Tumor necrosis factor; Uveitis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.2057

BackgroundDiagnostic delay in axial Spondyloarthritis (axSpA) is longer than in many other rheumatic diseases.It has been demonstrated to be associated with socioeconomic factors, disease presentation [1], HLA-B27 negativity, female sex, psoriasis and younger age at onset [2]. Prolonged delay is associated with poorer long-term outcomes, including functional impairment and quality of life.ObjectivesTo evaluate whether diagnostic delay in patients with radiographic axSpA (r-axSpA) is associated with poorer short-term outcomes after two years of follow-up.MethodsObservational, longitudinal and prospective study including patients from the REGISPONSER-AS study (Spondyloarthritis Registry of the Spanish Rheumatology) with a diagnosis of r-axSpA according to the modified NY criteria. At baseline, the patients were divided into two groups according to the median of diagnosis delay (<5 years, ≥5 years).Binary logistic regression models adjusted for disease duration were constructed to evaluate the association between the diagnosis delay and disease outcomes at two years. The retention rate of the first anti-TNF treatment across the groups was evaluated using a log-rank test.ResultsA total of 729 patients were included. Outcomes at two years according to diagnosis delay are presented in the Table 1. Characteristics related with structural chronic damage (BASRI, occiput wall distance), inflammatory bowel disease (IBD), dactylitis, SF-12 mental component and inability to work were associated with longer diagnosis delay. No differences were found in the retention rate of the first anti-TNF antibody between the groups.ConclusionDiagnostic delay is associated with poorer short-term outcomes in terms of structural damage, prevalence of IBD, dactylitis, SF-12 mental component and inability to work in patients with r-axSpA.References[1]Zhao SS et al. Diagnostic delay in axial spondyloarthritis: a systematic review and meta-analysis. Rheumatology (Oxford). 2021;60(4):1620-1628.[2]Redeker I et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford). 2019;58(9):1634-1638.Table 1.Outcomes at 2 years adjusted by disease durationDiagnosis delay <5 years (N = 364)Diagnosis delay 5 or more years (N = 365)OR (95% CI)p-value*Age (years) at diagnosis30.95 (10.53)39.42 (11.59)1.09 (1.07 – 1.1)<0.001Sex (male)274 (75.3)279 (75.8)1.28 (0.89 – 1.86)0.19HLA-B27 positive282 (81.3)292 (81.6)1.24 (0.81 – 1.88)0.321Psoriasis41 (11.5)39 (11)1.02 (0.61 – 1.73)0.926IBD19 (5.4)27 (7.6)0.41 (0.21 – 0.78)0.007Uveitis82 (23.2)83 (23.2)1.28 (0.87 – 1.88)0.215CRP (mg/dL)9.11 (14.62)9.43 (11.78)0.99 (0.99 – 1.01)0.796ASDAS-CRP, mean (SD)2.49 (0.99)2.67 (1.04)1.06 (0.9 – 1.25)0.47BASDAI, mean (SD)3.58 (2.15)4.07 (2.36)1.06 (0.99 – 1.14)0.109BASFI, mean (SD)36.63 (27.55)44.38 (27.1)1 (0.99 – 1.01)0.832VAS (cm)4.04 (2.55)4.4 (2.61)1.03 (0.97 – 1.1)0.333SF - 12 physical component36.76 (9.45)34.86 (9.97)0.99 (0.97 – 1)0.137SF - 12 mental component49.31 (9.85)48.46 (11.3)0.98 (0.97 – 0.99)0.04Radiographic sacroiliitis347 (96.7)356 (97.5)1.35 (0.54 – 3.4)0.523Spine BASRI6.55 (3.34)7.33 (3.03)0.94 (0.88 – 0.99)0.042Total BASRI7.32 (3.97)8.28 (3.65)0.94 (0.89 – 0.99)0.02Magnetic resonance11 (3)11 (3)1.07 (0.39 – 2.93)0.9Enthesitis133 (38.4)148 (41.2)1.03 (0.67 – 1.58)0.886Dactilytis39 (11.3)18 (5.1)0.47 (0.25 – 0.89)0.02Hip arthroplasty19 (5.5)18 (5.1)4.02 (1.86 – 8.69)< 0.001Schober (cm)3.23 (1.72)2.89 (1.62)1.09 (0.98 – 1.2)0.099Chest expansion (cm)4.24 (2.1)3.7 (2)0.99 (0.91 – 1.07)0.796Distance to ground (cm)18.02 (14.26)21.6 (13.95)1 (0.99 – 1.01)0.687Occiput wall distance (cm)4.13 (6.43)5.36 (6.64)0.97 (0.94 – 0.99)0.015Lumbar lateral flexion (cm)20.96 (18.01)19.06 (18.19)0.99 (0.99 – 1)0.778Inability to work -Transitory -Permanent14 (4.1) 90 (26.5)13 (3.8) 110 (31.9)1.5 (1.07 – 2.27)0.02* Binary logistic regressionAcknowledgementsThanks to all the patients and investigators from REGISPONSER.Disclosure of InterestsNone Declared.