Factors associated with diagnostic delay and specialty consultation patterns in systemic sclerosis: A cross-sectional...

Early diagnosis of Systemic Sclerosis (SSc) is challenging due to nonspecific symptoms and clinical overlap with other autoimmune diseases. To investigate factors associated with diagnostic delays in SSc, focusing on the number and specialties of physicians consulted before diagnosis. This cross-sectional study included SSc patients registered at a university rheumatology clinic. Demographics, clinical features, and physical examination findings were recorded. The number and specialties of physicians consulted before diagnosis were obtained through structured face-to-face interviews. Of 240 screened patients, 135 were included (120 female, 88.8%; 55 with diffuse SSc, 40.7%; mean age 52.1 ± 11.5 years). The median time to diagnosis was 36 months (IQR 12-96) from Raynaud's phenomenon (RP) onset and 11(IQR 0-35) months from the first non-RP symptom. Patients with limited SSc had a significantly longer RP-to-diagnosis interval than those with diffuse SSc (44 vs. 20 months, p = 0.024). The median number of physicians consulted before diagnosis was 3 (range 1-9). Higher educational level (IRR = 0.97, p = 0.036) and referral by a familiar healthcare professional (IRR = 0.78, p = 0.035) were independently associated with fewer pre-diagnostic consultations. Among 119 patients who recalled their first physician, 42 (35.3%) initially consulted an internist, 28 (23.5%) a family physician, 11 (9.2%) a dermatologist, and 10 (8.4%) a cardiovascular surgeon; the remainder visited other specialists. Only 8 patients (6.7%) received an SSc diagnosis at their first consultation. SSc diagnosis is often delayed, requiring multiple consultations. Greater physician awareness and timely rheumatology referrals are essential.