Ezra Zhe Shen Tan, Federic Yiong Poh Kho, Ahmed Shaheed, Jia Min Foo, Farahnurbain Ghazali, Ravinash Ratnam, Woon Shen Teo, Thayalan Ponniah, Fariz Yahya
In this Malaysian tertiary-care cohort, axSpA was associated with a median diagnostic delay of 48 months, with longer delays observed in radiographic disease and external referrals. Delayed recognition may reflect non-classical presentations and pathway-level barriers in referral coordination and specialist access. Greater awareness among primary care and non-rheumatology specialties, supported by structured referral criteria, minimum referral datasets, shared imaging pathways, and streamlined external referral processes, may improve timely rheumatology assessment.
OBJECTIVE: To evaluate diagnostic delay, referral pathways, presenting symptoms, and clinical characteristics among patients with axial spondyloarthritis (axSpA) managed at a Malaysian tertiary rheumatology centre.
METHODS: This retrospective observational study included adults with consultant-confirmed axSpA attending the Rheumatology Clinic, Universiti Malaya Medical Centre. Demographics, axSpA subtype, diagnostic delay, presenting symptoms, laboratory profiles, HLA‑B27 status, referral pathways, and treatments before and 6 months after diagnosis were recorded.
RESULTS: A total of 141 adults were included. This consisted of 87 males (61.7%) and was predominantly Chinese (n=83, 58.9%), followed by Malay (n=45, 31.9%), Indian (n=12, 8.5%), and other ethnicities (n=1, 0.7%). Radiographic axSpA and non‑radiographic axSpA accounted for 103 (73.0%) and 38 (27.0%) patients, respectively. Median age at symptom onset and diagnosis were 28 and 35 years. Median diagnostic delay was 48 months, and radiographic patients experienced longer delays (60 vs 36 months). Back pain was the commonest presenting symptom, with subtype‑specific variations in neck, shoulder, and peripheral joint involvement. External referrals had longer delays than internal referrals. Before diagnosis, 76.5% received NSAIDs, and 31.2% commenced biologic therapy within six months.
CONCLUSION: In this Malaysian tertiary-care cohort, axSpA was associated with a median diagnostic delay of 48 months, with longer delays observed in radiographic disease and external referrals. Delayed recognition may reflect non-classical presentations and pathway-level barriers in referral coordination and specialist access. Greater awareness among primary care and non-rheumatology specialties, supported by structured referral criteria, minimum referral datasets, shared imaging pathways, and streamlined external referral processes, may improve timely rheumatology assessment.