Clinical Factors Associated with Diagnostic Delay in Axial Spondyloarthritis in Saudi Arabia: A Retrospective Cohort Study

Background/Objectives: Diagnostic delay remains a major challenge in axial spondyloarthritis (axSpA), yet factors associated with delay in Saudi Arabia and the Arabian Gulf remain poorly characterized. We examined clinical factors associated with diagnostic delay in a single-center Saudi cohort.

Methods

This retrospective cohort included 160 of 220 screened registry patients with rheumatologist-confirmed axSpA who fulfilled ASAS classification criteria. Diagnostic delay was measured in whole years from documented symptom onset to diagnosis. Twenty-four patients had fibromyalgia documented before axSpA diagnosis. The primary negative binomial model included sex, axSpA subtype, HLA-B27 status, documented prediagnosis fibromyalgia, and symptom-onset age; logistic regression evaluated delay > 5 years. Standardized predictions estimated absolute differences, and a 2-year landmark analysis reduced differential opportunity for fibromyalgia ascertainment.