Diagnostic Delays in Axial Spondyloarthritis: Identifying Diagnostic Inequities in Immigrant Patients

Objectives In Axial spondyloarthritis (AxSpA), diagnostic delays remain a persistent challenge. Socioeconomic, cultural, and systemic factors may contribute to inequities in access to timely diagnosis, particularly among immigrant populations. This study aims to generate pilot data on diagnostic delays among immigrant patients with AxSpA and to compare these delays with those observed in non-immigrant populations. Methods This study is part of an ongoing prospective data collection using a single-visit, cross-sectional design. Participants were consecutively recruited from 2 clinical settings within our rheumatology program: (1) the AxSpA Triage Clinic (FASTRAX*), which evaluates patients with suspected AxSpA, and (2) the ORCHESTRA (Ottawa Rheumatology CompreHEnSive TReatment and Assessment) Clinic, which follows patients with established, active AxSpA requiring biologic therapy and managed through a standardized approach. Demographic and clinical data were collected, including place of birth, and symptom duration. Diagnostic confirmation of AxSpA was made by a rheumatologist based on clinical evaluation and imaging findings. The primary outcome was diagnostic delay, defined as the time interval from symptom onset to rheumatologist-confirmed diagnosis of AxSpA. Immigrant status was determined by country of birth (Canada-born vs foreign-born). Comparative analyses were performed between immigrant and non-immigrant patients. Results A total of 81 patients were enrolled to date (44 females and 37 males). AxSpA was confirmed in 51 patients, while 30 were determined to have non-SpA back pain. The mean duration from symptom onset to final diagnosis (or exclusion) was 10.1 years (SD ±10.8) overall, 9.6 ±10.8 years among patients diagnosed with AxSpA, and 11.1 ±11.2 years among those with non-SpA back pain. Of the total cohort, 67 patients were Canadian-born and 14 were immigrants. Among Canadian-born patients, 41 were diagnosed with AxSpA, with a mean diagnostic delay of 8.8 years (SD ±10.7). Among immigrants, 10 were diagnosed with AxSpA, with a longer mean diagnostic delay of 12.7 years (SD ±10.9). In parallel, perceived delays in care showed same trends: within immigrant patients, 40% stated moderate-severe delays for access to rheumatology and 30% for imaging, compared to non-immigrants (22% for access to rheumatology; and 7.5% for the imaging) (Table 1). Table 1. Perceived Delays in Referrals to Rheumatology and Imaging Service Conclusion Our pilot data suggest longer diagnostic delays in AxSpA among immigrant patients compared with those born in Canada. Although the sample size is small and lacks statistical power, consistent trends indicate potential inequities in access to rheumatology assessment and imaging. These findings highlight the importance of considering social and systemic factors that may contribute to diagnostic disparities.