RT Journal Article
SR Electronic
T1 Changes in ankylosing spondylitis incidence, prevalence and time to diagnosis over two decades
JF RMD Open
JO RMD Open
FD EULAR
SP e001888
DO 10.1136/rmdopen-2021-001888
VO 7
IS 3
A1 Crossfield, Samantha S R
A1 Marzo-Ortega, Helena
A1 Kingsbury, Sarah R
A1 Pujades-Rodriguez, Mar
A1 Conaghan, Philip G
YR 2021
UL http://rmdopen.bmj.com/content/7/3/e001888.abstract
AB Objectives To assess changes in ankylosing spondylitis (AS) incidence, prevalence and time to diagnosis, between 1998 and 2017.Methods Using UK GP data from the Clinical Practice Research Datalink, we identified patients diagnosed with AS between 1998 and 2017. We estimated the annual AS incidence, prevalence and length of time from first recorded symptom of back pain to rheumatology referral and diagnosis.Results We identified 12 333 patients with AS. The incidence declined from 0.72 (±0.14) per 10 000 patient-years in 1998 to 0.39 (±0.06) in 2007, with this decline significant only in men, then incidence rose to 0.57 (±0.11) in 2017. By contrast, prevalence increased between 1998 and 2017 (from 0.13%±0.006 to 0.18%±0.006), rising steeply among women (from 0.06%±0.05 to 0.10%±0.06) and patients aged ≥60 (from 0.14%±0.01 to 0.26%±0.01). The overall median time from first symptom to rheumatology referral was 4.87 years (IQR=1.42–10.23). The median time from first symptom to diagnosis rose between 1998 and 2017 (from 3.62 years (IQR=1.14–7.07) to 8.31 (IQR=3.77–15.89)) and was longer in women (6.71 (IQR=2.30–12.36)) than men (5.65 (IQR=1.66–11.20)).Conclusion AS incidence declined significantly between 1998 and 2007, with an increase between 2007 and 2017 that may be explained by an improvement in the recognition of AS or confidence in diagnosing AS over time, stemming from increased awareness of inflammatory back pain and the importance of early treatment. The rising AS prevalence may indicate improved patient survival. The persisting delay in rheumatology referral and diagnosis remains of concern, particularly in women.Data may be obtained from a third party and are not publicly available. The CPRD data were provided under a licence that does not permit sharing. The code-lists used in definitions and the derived results are published in the manuscript and supporting file.