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Current benchmarks of delay are usually reported as mean data, which are typically skewed and therefore may be overestimating delay. Our aim was to determine the extent of median delay patients\u2019 experience in receiving a diagnosis of axSpA and examine whether specific factors are associated with the presence of such delay. We conducted a systematic review across five literature databases (from inception to November 2021), with studies reporting the average time period of diagnostic delay in patients with axSpA being included. Any additional information examining associations between specific factors and delay were also extracted. A narrative synthesis was used to report the median range of diagnostic delay experienced by patients with axSpA and summarise which factors have a role in the delay. From an initial 11,995 articles, 69 reported an average time period of diagnostic delay, with 25 of these providing a median delay from symptom onset to diagnosis. Across these studies, delay ranged from 0.67 to 8 years, with over three-quarters reporting a median of between 2 years and 6 years. A third of all studies reported median delay data ranging from just 2 to 2.3 years. Of seven variables reported with sufficient frequency to evaluate, only \u2018gender\u2019 and \u2018family history of axSpA\u2019 had sufficient concordant data to draw any conclusion on their role, neither influenced the extent of the delay. Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay and this remains an extensive worldwide problem. This is further compounded by a mixed picture of the disease, patient and healthcare-related factors influencing delay.<jats:table-wrap><jats:table><jats:tbody><jats:tr><jats:td colspan=\"2\"><jats:bold>Key points<\/jats:bold><jats:italic>\u2022 Despite improvements in recent decades, patients with axSpA frequently experience years of diagnostic delay.<\/jats:italic><jats:italic>\u2022 Median diagnostic delay typically ranges from 2 to 6 years globally.<\/jats:italic><jats:italic>\u2022 Neither \u2018gender\u2019 nor \u2018family history of axSpA\u2019 influenced the extent of diagnostic delay experienced.<\/jats:italic><jats:italic>\u2022 Diagnostic delay based on mean, rather than median, data influences the interpretation of the delay time period and consistently reports a longer delay period.<\/jats:italic><\/jats:td><\/jats:tr><\/jats:tbody><\/jats:table><\/jats:table-wrap><\/jats:p>","DOI":"10.1007\/s10067-022-06100-7","type":"journal-article","created":{"date-parts":[[2022,2,19]],"date-time":"2022-02-19T14:04:26Z","timestamp":1645279466000},"page":"1939-1950","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":75,"title":["Diagnostic delay in axial spondyloarthritis: a systematic review"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3496-7044","authenticated-orcid":false,"given":"Charles A.","family":"Hay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5531-1680","authenticated-orcid":false,"given":"Jon","family":"Packham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2202-6266","authenticated-orcid":false,"given":"Sarah","family":"Ryan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2677-1028","authenticated-orcid":false,"given":"Christian D.","family":"Mallen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4533-2474","authenticated-orcid":false,"given":"Alexandros","family":"Chatzixenitidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9213-2796","authenticated-orcid":false,"given":"James A.","family":"Prior","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,19]]},"reference":[{"key":"6100_CR1","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1080\/14397595.2020.1830512","volume":"31","author":"H Kameda","year":"2021","unstructured":"Kameda H, Kobayashi S, Tamura N, Kadono Y, Tada K, Yamamura M, Tomita T (2021) Non-radiographic axial spondyloarthritis. 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