Rheumatologic disorders

Alexis Ogdie-Beatty, MD, MSCE, on the Diagnostics of Ankylosing Spondylitis

Patients with ankylosing spondylitis (AS) often experience a delay from symptom onset to diagnosis of AS. Therefore, understanding AS and its diagnosis, and having the ability to identify opportunities to reduce misdiagnosis and incorrect referral could prevent negative outcomes for this patient population.

Alexis R. Ogdie-Beatty, MD, MSCE, assistant professor of medicine at the Hospital of the University of Pennsylvania, is the lead author of a study1 about the topic and answered our questions about the outcomes of her research. 

Rheumatology Consultant: How did your study come about?

Alexis Ogdie-Beatty: There is a known delay in the diagnosis of AS of 8 to 10 years.  We wanted to examine the pathway to diagnosis to see if there are spots along the way we could intervene. To learn more, we surveyed members of CreakyJoints, the nonprofit, online patient advocacy organization.

RHEUM CON: Why are patients with AS likely to experience a delay from symptom onset to diagnosis?

AOB: Back pain is quite common, so physicians often first assume it is mechanical back pain or muscular pain and do not necessarily work it up (patients may not even go to a physician).

RHEUM CON: How often are patients misdiagnosed or incorrectly referred? And what is the effect of this?

AOB: People are frequently misdiagnosed (and this can go both ways—sometimes people are misdiagnosed with AS, too). The effect of missing the diagnosis is that the earlier we start therapy for AS, the better the long-term outcomes. Therefore, a delay in diagnosis can result in more damage and more disability.

RHEUM CON: Your study results indicate that women had a mean of 17.2 years since first symptom onset and 7.5 years since AS diagnosis; whereas men had a mean of 20 years since first symptom onset and 11.4 years since AS diagnosis. Why might the time be shorter for women?

AOB: We did not specifically explore this but in other studies, women tend to more readily go to the doctor.

RHEUM CON: Why do gender differences persist in misdiagnosis of AS?

AOB: One of the interesting factors is that most physicians consider AS a primarily male disease, but more recent studies have found that the male-to-female ratio is less than previously thought.  This can result in a delay among women.  We also need to get men with these symptoms into the physician and capturing them earlier.

For more on ankylosing spondylitis, visit Rheumatology Consultant.

1.    Ogdie A, Nowell WB, Reynolds R, et al. Diagnosis journey of patients with ankylosing spondylitis in the United States. Ann Rheum Dis. 2018;(77):631-632. doi:10.1136/annrheumdis-2018-eular.5640