Identifying parameters associated with delayed diagnosis in axial spondyloarthritis: data from the European map of axial spondyloarthritis.

OBJECTIVE: To identify the parameters associated with self-reported diagnostic delay (DD) in axial spondyloarthritis (axSpA) patients across Europe. METHODS: Data from 2652 patients from 13 countries who participated in the European Map of Axial Spondyloarthritis (EMAS) were collected through an online survey (2017-2018). DD was calculated as the difference between age at diagnosis and age at symptom onset reported by participants. Associations between DD and sociodemographic characteristics, as well as disease-related factors were explored through univariable and multivariable linear regression analysis. RESULTS: Average DD was 7.4 (8.4) years with a variation between countries. The variables associated with longer DD in the final multivariable regression model were: younger age at symptom onset (b = -0.26; 95% CI: -0.28, -0.23), female gender (b = 1.34; 95% CI: 0.73, 1.96) and higher number of health-care professionals (HCPs) seen before diagnosis (b = 1.19; 95% CI: 0.95, 1.43). There was a significant interaction between the female gender and the number of HCPs seen before diagnosis. A substantial variation of the DD across European countries was observed. CONCLUSION: In this sample of axSpA patients, average DD was greater than 7 years. Younger age at symptom onset, female gender, higher number of HCPs seen before diagnosis, and being diagnosed by rheumatologist were the parameters associated with a longer DD in axSpA. These findings indicate a need for continuing efforts dedicated to recognition of patients with a high probability of axSpA on the level of non-rheumatology specialists and facilitating referral to a rheumatologist for timely diagnosis.

Upswings in Cheerful Mood and Disease Activity in Patients with Rheumatoid Arthritis.

PURPOSE: The influence of a cheerful mood on disease activity levels in rheumatoid arthritis is investigated in this cross-sectional study. METHOD: State cheerfulness (i.e., how individuals feel at the time of the assessment) and trait cheerfulness (i.e., how individuals usually feel) were assessed at the same time as the clinical indicators of disease activity and just before measuring patient-reported disease activity with the Disease Activity Score-28 (DAS-28). RESULTS: State cheerfulness contributed significantly to the variance in the DAS-28 scores that was not accounted for by trait cheerfulness or demographic or clinical variables. Higher state cheerfulness was associated with lower values of self-reported disease activity and C-reactive protein. The patient-reported disease activity was not uniquely caused by the clinical indicators of disease, but it also depended on patients' cheerful mood at the moment of assessment. CONCLUSION: The findings suggest interesting possibilities for the diagnosis and monitoring of disease activity in rheumatoid arthritis.