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.

An Initial Diagnosis of Lumbar Disc Herniation Is Associated with a Late Refferral to the Rheumatologist and a Delay in the Diagnosis of Ankylosing Spondylitis.

Akar1,  Servet, Gerdan1,  Vedat, Solmaz1,  Dilek, Sayarlioglu4,  Mehmet, Ozturk2,  Mehmet Akif, Onat3,  Ahmet Mesut, Kisacik3,  Bünyamin

Rheumatology, Dokuz Eylul Univerisity Faculty of Medicine, Izmir, Turkey
Rheumatology, Gazi University, Ankara, Turkey
Rheumatology, Gaziantep University Faculty of Medcine, Gaziantep, Turkey
Rheumatology, KahramanMaras Sutcu Imam University Faculty of Medicine, KahramanMaras, Turkey


Among all the rheumatologic diseases, AS still remains to be the one with, the longest diagnostic delay mostly due to the slow development of radiographic sacroiliitis. In clinical practice, many patients with AS are diagnosed to have lumbar disk herniation (LDH), which in our opinion might be one of the the possible determinants of diagnostic delay in these patients. In this study we assessed the diagnostic delay in AS patients with an initial diagnosis of LDH compared with those without such diagnosis.

Patients and Methods:

393 patients (258 male [65,6%], mean age 39,3 ± 10,8 years) with AS according to the modified New York criteria from five rheumatology clinics in different cities were included in this analysis. A face to face interview was performed by using a structured questionnaire addressing all the possible factors that may lead to diagnostic delay, including the specialty of the first consulted physician, the initial diagnosis and history for LDH. Total diagnostic delay was calculated as the time elapsed from the initial visit to the physician due to back pain until the diagnosis of AS. Factors associated with the diagnostic delay were evaluated by Spearman's correlation and linear regression methods


An initial diagnosis of LDH was reported by 33% of the 300 patients who could answer this question. The diagnostic delay in patients with an initial diagnosis of LDH vs those without such diagnosis was 9.1± 8,5 years and 6,2±7,4, years, respectively (p=0.002). Twenty six patients had undergone operation for LDH and the diagnostic delay in those patients was markedly higher than the patients without LDH surgery (13,3 ± 11,3 vs 6.2 ± years, P=0,023). Referral time to the rheumatologist was also significantly greater in patients with an initial diagnosis of LDH and in patients with a history of LDH surgery compared to the others.

Rheumatologists were seen as the initial physicians by only 4% of the patients whereas, 30% consulted physiatrist, 25% consulted orthopedists and 16% consulted orthopedists at their 1st medical visit due to back pain. The shortest delay in diagnosis was observed when rheumatologists were the first consulted physicians (2,9 ± 5,3 years).The delay period for the physiatrists was shorter (6,3 ± 7,6 years) than the orthopedists (9,6 ± 9,1 years) and neurosurgeons (8,8 ± 6,6 years). However, diagnostic delay was not found to be correlated with sex, family history, HLA-B 27 status and acute phae response. In the linear regression analysis age at spondyloarthritic symptom onset (p=0,013), age at back pain onset (p=0,01), and education level (p=0,003) were also found to be significant predictors of the diagnostic delay.


Our results suggest that prior diagnosis of LDH may lead to late referral of AS patients to rheumatologists resulting in a delay in diagnosis. A relatively high percentage of patients with LDH surgery is of concern, pointing out the necessity of continuous medical education of the specialists who are likely to see patients with AS, on the concept of spondyloarthritis.

To cite this abstract, please use the following information:
Akar, Servet, Gerdan, Vedat, Solmaz, Dilek, Sayarlioglu, Mehmet, Ozturk, Mehmet Akif, Onat, Ahmet Mesut, et al; An Initial Diagnosis of Lumbar Disc Herniation Is Associated with a Late Refferral to the Rheumatologist and a Delay in the Diagnosis of Ankylosing Spondylitis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1921
DOI: 10.1002/art.29686

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