Delayed Diagnosis Adversely Affects Outcome in Systemic Lupus Erythematosus: Article Review
By Dr. Robert Katz
An article in the journal Lupus discusses delayed diagnosis. The conclusion of the authors is that a longer time to diagnosis was associated with worse outcomes. The average duration between the onset of symptoms and the diagnosis of lupus was almost four years. The longer the time to diagnosis, the higher the disease activity, the disease-related damage, and fatigue, and lower health-related quality of life. This was based on a self-report from patients, with the patient filling out the onset of first symptoms, the first physician visit, and the time of diagnosis reported by this self-administered questionnaire among lupus patients in Germany 2012.
The early symptoms of lupus are often nonspecific and may mimic other medical conditions, increasing the risk for diagnostic delay. In one study of 121 lupus patients in England, 70 percent of the participants stated that they had initially received another diagnosis. It often took 10 consultations with three different doctors before a diagnosis was finally made.
Despite the fact that there are improved diagnostic techniques and especially sophisticated blood testing for antibodies, the interval between first symptoms and a diagnosis of lupus can still be quite long. Reducing this delay may allow monitoring and treatment at an earlier stage before severe organ involvement might occur. In a Danish study of 100 patients with kidney lupus followed for 15 years, a delayed diagnosis and treatment increased the risk of progression to end-stage kidney disease.
The effect on quality of life, mental stability, and other issues such as fatigue, can depend on an early diagnosis and treatment in lupus patients. Optimized access routes to rheumatologists may facilitate earlier diagnosis before organ damage can occur.
In a study “Joint Involvement Influences Quality of Life in Systemic Lupus Erythematosus Patients,” the authors conclude that joint involvement can represent the major determiner of quality of life in lupus patients. In this study, lupus patients with joint involvement were compared to those without this feature, and disease activity was assessed as well as a lupus quality of life questionnaire. There was a significant correlation between the joint symptoms and lupus quality of life. Joint involvement is the most common feature seen in lupus patients with a prevalence ranging from 70 to 95 percent in different studies. There is a great variety of manifestations, from joint aches to more severe joint damage. Quality of life is significantly affected by joint pain. Lupus, volume 30, 2021.
Robert S. Katz, M.D.