Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.

Time to Diagnosis of Ankylosing Spondylitis in an Irish Cohort and the Effect on Work Disability.

Sullivan2,  Catherine, FitzGerald1,  Oliver M.

Department of Rheumatology, St Vincents University Hospital, Ranelagh Dublin, Ireland
Department of Rheumatology, St Vincents University Hospital, Elm Park, Dublin 4, Ireland


Ankylosing Spondylitis (AS) is characterised by inflammatory back pain which may be associated with peripheral arthritis, enthesitis or uveitis. It has an insidious onset and results in radiographic progression with resultant pain, stiffness and loss of function. Studies have shown a delay in diagnosis of up to 7 years from onset of symtpoms.1 Because there is no unique laboratory test to help in the diagnosis in primary care it is difficult to identify the 5% of patients with lower back pain who may have a spondyloparthropathy (SpA), including AS.2 Research has demonstrated that patients with AS may have substantial periods of sick leave leading to a significant socioeconomic cost.3


We sought to identify the average time to diagnosis of AS from sypmtom onset in an Irish cohort and further to identify patterns of work disability in this group.


Patients with AS (n=100) were identified from the physiotherapy database of a Dublin tertiary referral rheumatology department. Patients were sent a postal questionnaire about disease onset, diagnosis, treatment and employment status. All replies were anonymous and 59% responded.


Of the respondants 59% were male, the average age of onset of symptoms was 25 years (yrs), with diagnosis at 32 yrs and the average age when completing the survey was 44 yrs. 96.6% had some spinal involvement with 23.7% having only spinal involvement. The average time from symptom onset to diagnosis was 7.25 yrs (min 0, max 23).

74.6% of patients were on an anti-TNF agent alone, with 8.5% on an anti-TNF agent plus a synthetic disease modifying agent (DMARD), 3.4% on DMARD alone and 13.5% on neither. The time to diagnosis of AS did not impact on treatment protocol.

In total 30.5% of respondants reported not being in employment as a result of AS. 20% of those diagnosed in under 4 yrs from symptom onset were unemployed. This rose to 29.4% in those diagnosed between 5 and 9 yrs after onset and a staggering 41% of patients were unemployed in patients whose disease diagnosis was delayed by more than 10 yrs. 62.5% of participants who were off work said they did not anticipate returning to emplyment in the next 12 months.


In this cohort of Irish patients we see a delay in diagnosis of AS of 7 years, similar to that seen in studies in 1998 and 2003. This suggests a persistent problem with under recognition of SpA in primary care. Additionally, while not designed to look at all aspects of work disability, these data suggest a correlation between the time to diagnosis of AS and work disability. In light of these results a new diagnostic pathway for SpA has been developed and distributed to Irish General Practitioners.


1.Feldtkeller, E, Khan, MA, van der Heijde, D, van der Linden, S & Braun, J. Rheumatol Int 2003;23:61-6.

2.Underwood, MR & Dawes, P. Br J Rheumatol 1995;34:1074-7.

3.Annelies, Boonen, Tjinta, Brinkhuizen & Robert, Landewé, et al. Ann Rheum Dis 2010;69:1123-1128

To cite this abstract, please use the following information:
Sullivan, Catherine, FitzGerald, Oliver M.; Time to Diagnosis of Ankylosing Spondylitis in an Irish Cohort and the Effect on Work Disability. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :555
DOI: 10.1002/art.28324

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