Background Systemic lupus erythematosus (SLE) often mimics the symptoms of other diseases, and the interval between symptom onset and diagnosis remains long in these patients. The aim of this study is to examine the variables associated with a delay to diagnosis and their impact in damage accrual and mortality in patients with SLE.
Methods GLADEL a multi-ethnic, multi-national Latin-American SLE inception cohort was studied. Patients were recruited based on the physicians’ diagnosis but 97% fulfilled the ACR criteria. Delay to diagnosis was defined as ≥6 months from the first ACR criterion to SLE diagnosis. Socio-demographic, clinical/laboratory, disease activity, damage and mortality were compared using descriptive statistical tests. Multivariable Cox regression (HR) model with damage accrual and mortality as the end points were performed.
Results Of the 1437 included in this analysis, the median delay to diagnosis was 5.9 months (Q1-Q3 2.4–16.1) and 721 (50.2%) had ≥6 months delay in SLE diagnosis. Patients with delay in diagnosis were more frequently of female gender, older age at diagnosis, mestizo ethnicity and without medical insurance. The characteristics of patients according to delay in diagnosis are depicted in table 1. Delay to diagnosis did not impact on disease outcome: damage accrual [HR 1.21 (IC 95% 0.78–1.88; p=0.39)] and mortality [HR 1.30, CI 95% 0.84–2.01; p= 0.24)], after adjusting for age at SLE diagnosis, gender, ethnicity and socioeconomic status.
Conclusions In the GLADEL cohort, delay to diagnosis was associated to sex, age, thrombosis, sicca syndrome, cutaneous and neurological involvement. Furthermore, delay to diagnosis had no apparent negative impact on disease outcome (damage accrual and mortality). Early referral when there are suspicious clinical manifestations of SLE is crucial to reduce the diagnostic delay.
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