Diagnostic delay in axial spondyloarthritis - a past or current problem?

To evaluate recent data on diagnostic delay in axial spondyloarthritis (axSpA), factors affecting the delay, potential ways of early diagnosis improvement, and risks associated with early diagnostic approaches.

Although axSpA can be diagnosed nowadays within the first months after symptom onset, the diagnostic delay remains with several years still remarkably high in many parts of the world. Female gender, human leukocyte antigen-B27 negativity, and younger age at disease onset are among factors associated with a delayed referral to a rheumatologist and consequently with a larger diagnostic delay. Early referral algorithms are helpful in the identification of patients with a high probability of axSpA among patients with chronic back pain. A careful diagnostic evaluation with correct imaging interpretation is required to avoid misdiagnosis of axSpA in patients with unspecific back pain.

The diagnostic delay is still considerable in axSpA. The ways to early diagnosis in axSpA are well defined. Imaging findings should always be considered in the clinical context to avoid axSpA misdiagnosis.