HIGHER CARDIOVASCULAR MORBIDITY SEEN IN MEN WITH LONGER DELAY TO THE DIAGNOSIS OF AXIAL SPONDYLOARTHRITIS

BackgroundDiagnostic delay in axial spondyloarthritis (axSpA) is a well-defined feature of the disease, despite increased awareness. Morbidity and mortality are higher in axSpA than the general population1. Much of this excess burden is due to increased comorbidity. However, the association between delayed diagnosis and increased comorbidity in this population is unknown.Objectives(1)Examine the relationship between delayed diagnosis and comorbidity in a large cohort of well characterised individuals with axSpA(2)Assess the impact of sex on the relationship between diagnostic delay and comorbidity.MethodsThe Ankylosing Spondylitis Registry of Ireland (ASRI), a descriptive epidemiological study of the Irish axSpA population, provided the cohort for this study. A standardised clinical assessment was performed on each patient. Delay to diagnosis was calculated as age at diagnosis minus age at symptom onset. Comorbidities were considered as any condition present in addition to axial SpA, excluding extra-musculoskeletal manifestations (EMM). SPSS was used for statistical analysis, with appropriate tests used for normally and non-normally distributed data.ResultsOf the 913 included patients, 659 (72%) were male and mean age was 46 years (SD 13). Detailed baseline clinical and demographic characteristics are outlined in Table 1. Median delay to diagnosis was 5 (2, 12) years. Comorbidity was present in 37% (n=341) of the cohort, with hypertension the most prevalent (see Figure 1).Table 1.Baseline demographic and clinical characteristicsVariableAge, mean (SD)45.8 (12.6)Female, n (%)254 (27.8)Caucasian, n (%)819 (96.5)Ever Smoker, n (%)*527 (57.7)HLA-B27 positive, n (%)631 (89.9)Disease duration, median (25th,75th)17.1 (9.5, 27.8)Delay to diagnosis, median (25th, 75th)5.0 (2.0, 12.0)AAU, n (%)308 (34.4)PsO, n (%)150 (16.7)IBD, n (%)96 (10.7)Biologic use, n (%)628 (68.5)BASMI, mean (SD)3.6 (2.1)BASFI, mean (SD)3.4 (2.9)BASDAI, mean (SD)3.9 (2.4)HAQ, median (25th, 75th)0.38 (0.0, 0.9)The median delay to diagnosis was significantly longer in those with ≥1 comorbidity compared to those with none (7 v 5 years, p<0.01). Hypertension (6 v 5 years, p=0.1) and cerebrovascular disease (10 v 5 years, p=0.03) were associated with a significantly longer delay to diagnosis, with a similar trend seen in those with hyperlipidaemia (7 v 5 years, p=0.09) and ischaemic heart disease (10 v 5 years, p=0.07). The delay to diagnosis was also longer in those that currently (7 v 5 years, p=0.03) or ever smoked (6 v 5 years, p<0.01). The delay to diagnosis was significantly longer in those with depression (9 v 5, p<0.05). The presence of EMM did not contribute to a delay to diagnosis, and there was no association with any categories of medication.There was no significant difference in the median delay to diagnosis between females (5 v 6 years) for males. However, there were differences in the relationship between delay to diagnosis and the pattern of comorbidities between sexes. There was a significantly (p<0.05) longer delay to diagnosis in men with cerebrovascular disease (12 v 6 years), ischaemic heart disease (10 v 6 years) and diabetes (10 v 6 years), which wasn’t evident in females. Depression was associated with a longer delay to diagnosis in males (10 v 6 years, p<0.05), but not females (6 v 5 years, p=0.5).ConclusionDelay to diagnosis of axSpA was associated with a higher prevalence of comorbidities. This was particularly evident in men, with higher cardiovascular morbidity in those with a longer delay to diagnosis. Further research is needed to determine if shortening the delay to diagnosis would reduce the burden of cardiovascular morbidity.References[1]Chaudhary et al. All-Cause and Cause-Specific Mortality in Psoriatic Arthritis and Ankylosing Spondylitis: A Systematic Review and Meta-Analysis. Arthritis Care Res. 2021 Nov 17 (online).Disclosure of InterestsNone declared