{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T02:56:40Z","timestamp":1777777000316,"version":"3.51.4"},"reference-count":24,"publisher":"Walter de Gruyter GmbH","issue":"3","license":[{"start":{"date-parts":[[2021,8,26]],"date-time":"2021-08-26T00:00:00Z","timestamp":1629936000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Background.<\/jats:bold>\n                    A large number of comparative studies have been conducted for ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA), including disease burden, treatment modalities and patient characteristics. The aim of this study was to compare physician related diagnostic delay time between patients with AS and nr-axSpA.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods.<\/jats:bold>\n                    In our retrospective study we included 266 patients with axSpA. Patients were classified into two subgroups, AS and nr-axSpA. The time from back pain onset until diagnosis of axSpA was defined as the diagnostic delay. The first specialist referred to and the first diagnosis for each patient was noted in detail. Patient characteristics, clinical manifestations and laboratory and imaging results at diagnosis were also compared between subgroups.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results.<\/jats:bold>\n                    The diagnostic delay time was significantly longer for AS patients [6 \u00b1 8.14 years vs 1.62 \u00b1 2.54 years]. 40.9% of all patients were initially consulted by specialists in physical therapy and rehabilitation, followed by 29.7% consulted by a neurosurgeon and 19.9% by a rheumatologist. The most common initial diagnosis was fibromyalgia, 52.6% (140), followed by ankylosing spondylitis, 28.9% (77), and lumbar disc hernia, 12.7% (34).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusion.<\/jats:bold>\n                    The vast majority of patients were initially evaluated by healthcare providers other than rheumatologists and mostly diagnosed with fibromyalgia. Efforts to increase awareness and to educate first healthcare providers may shorten the diagnostic delay time.\n                  <\/jats:p>","DOI":"10.2478\/rjim-2021-0004","type":"journal-article","created":{"date-parts":[[2021,4,6]],"date-time":"2021-04-06T06:07:24Z","timestamp":1617689244000},"page":"278-285","source":"Crossref","is-referenced-by-count":1,"title":["A single center experience: physician related diagnostic delay and demographic and clinical differences between patients with ankylosing spondylitis and non-radiographic axial spondyloarthritis"],"prefix":"10.2478","volume":"59","author":[{"given":"Firdevs","family":"Uluta\u015f","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Veli","family":"\u00c7obankara","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hande","family":"\u015eenol","sequence":"additional","affiliation":[{"name":"Department of Biostatistics , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"U\u011fur","family":"Karasu","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Serdar","family":"Kaymaz","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Canan Albayrak","family":"Ya\u015far","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeynep D\u00fcndar","family":"\u00d6k","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"Yi\u011fit","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine , Pamukkale University Faculty of Medicine , Denizli , Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"374","published-online":{"date-parts":[[2021,8,26]]},"reference":[{"key":"2026042915193744192_j_rjim-2021-0004_ref_001","doi-asserted-by":"crossref","unstructured":"1. 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Radiographic sacroiliitis develops predictably over time in a cohort of familial spondyloarthritis followed longitudinally. Rheumatology (Oxford). 2017;56(5):811\u20137.10.1093\/rheumatology\/kew49628160002","DOI":"10.1093\/rheumatology\/kew496"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_004","doi-asserted-by":"crossref","unstructured":"4. PROTOPOPOV M, PODDUBNYY D. Radiographic progression in non-radiographic axial spondyloarthritis. Expert Rev Clin Immunol. 2018;14(6):525\u201333.10.1080\/1744666X.2018.147759129774755","DOI":"10.1080\/1744666X.2018.1477591"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_005","unstructured":"5. MALAVIYA AP, OSTOR AJ. Early diagnosis crucial in Ankylosing Spondylitis. Practitioner. 2011;255(1746):21\u20134."},{"key":"2026042915193744192_j_rjim-2021-0004_ref_006","doi-asserted-by":"crossref","unstructured":"6. KILTZ U, BARALIAKOS X, KARAKOSTAS P, IGELMANN M, KALTHOFF L, KLINK C., et al. Do patients with non-radiographic axial spondylarthritis differ from patients with ankylosing spondylitis? Arthritis Care Res (Hoboken). 2012;64:1415\u201322.","DOI":"10.1002\/acr.21688"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_007","doi-asserted-by":"crossref","unstructured":"7. RUDWALEIT M, LANDEWE R, VAN DER HEIJDE D, L\u0130ST\u0130NG J, BRANDT J, BRAUN J, et al. The development of Assessment of Spondylo Arthritis international Society classification criteria for axial spondyloarthritis: classification of paper patients by expert opinion including uncertainty approisal. Ann Rheum Dis 2009;68(6):770\u20136.10.1136\/ard.2009.10821719297345","DOI":"10.1136\/ard.2009.108217"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_008","doi-asserted-by":"crossref","unstructured":"8. H S GO\u0130E THE, M M STEVEN, S M VAN DER L\u0130NDEN, A CATS. 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Ankylosing spondylitis diagnosis in US patients with back pain: identifying providers involved and factors associated with rheumatology referral delay. Clin Rheumatol. 2016;35:1769\u201376.10.1007\/s10067-016-3231-z491452426987341","DOI":"10.1007\/s10067-016-3231-z"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_011","doi-asserted-by":"crossref","unstructured":"11. VEDAT G, SERVET A, DILEK S, YAVUZ P, AHMET M O, BUNYAM\u0130N K, et al. Initial Diagnosis of Lumbar Disc Herniation is Associated with a delay in Diagnosis of Ankylosing Spondylitis. J Rheumatol. 2012;39:1996\u20139.10.3899\/jrheum.12010622859360","DOI":"10.3899\/jrheum.120106"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_012","doi-asserted-by":"crossref","unstructured":"12. BOYER GS, TEMPLIN DW, BOWLER A, LAWRENCE R C, EVERETT D F, HEYSES P, et al. A comparison of patients with SpA seen in specialty clinics with those identified in a community wide epidemiologic study. Arch Intern Med. 1997;157(18):2111\u20137.10.1001\/archinte.1997.00440390111014","DOI":"10.1001\/archinte.1997.00440390111014"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_013","doi-asserted-by":"crossref","unstructured":"13. SHMAGEL A, FOLEY R, IBRAHIM H. Epidemiology of chronic low back pain in US adults: data from the 2009\u20132010 National Health and Nutrition Examination Survey. Arthritis Care Res. 2016;68:1688\u201394.10.1002\/acr.22890502717426991822","DOI":"10.1002\/acr.22890"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_014","doi-asserted-by":"crossref","unstructured":"14. DANVE A, O\u2019DELL J. The ongoing quest for biomarkers in ankylosing spondylitis. Int J Rheum Dis. 2015;18:826\u201334.10.1111\/1756-185X.1277926469363","DOI":"10.1111\/1756-185X.12779"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_015","doi-asserted-by":"crossref","unstructured":"15. ARNBAK B, GRETHEJURIK A, HORSLEV PETERSEN K, HENDR\u0130CKS O, HERMANSEN L T, LOFT A G, et al. Associations between spondyloarthritis features and magnetic resonance imaging findings: A cross-sectional analysis of 1,020 patients with persistent low back pain. Arthritis Rheumatol. 2016;68(4):892\u2013900.10.1002\/art.3955126681230","DOI":"10.1002\/art.39551"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_016","doi-asserted-by":"crossref","unstructured":"16. MANDL P, NAVARRO-COMPAN V, TERSLOW L, P AEGERTER, D VAN DER HE\u0130JDE, M A D'AGOST\u0130NO, et al. EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice. Ann Rheum Dis. 2015;74(7):1327\u201339.10.1136\/annrheumdis-2014-20697125837448","DOI":"10.1136\/annrheumdis-2014-206971"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_017","doi-asserted-by":"crossref","unstructured":"17. SIZHENG STEVEN ZHAO, JOERG ERMANN, CHANG XU, CHANG XU, HOUCHEN LYU, SARA K TEDESCH\u0130, KATHER\u0130NE P L\u0130AO, et al. Comparison of comorbidities and treatment between ankylosing spondylitis and non-radiographic axial spondyloarthritis in the United States. Rheumatology 2019;58(11):2025\u201330.10.1093\/rheumatology\/kez171796789431081033","DOI":"10.1093\/rheumatology\/kez171"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_018","doi-asserted-by":"crossref","unstructured":"18. CLEMENTINA MEDINA, SOFIA RAMIRO, DESIREE VAN DER HEIJDE, JOACHIM SIEPER, MAXIME DOUGADOS, ANNA MOLTO. Characteristics and burden of disease in patients with radiographic and non-radiographic axial Spondyloarthritis: a comparison by systematic literature review and meta-analysis. RMD Open. 2019;5:e001108.10.1136\/rmdopen-2019-001108689039331803500","DOI":"10.1136\/rmdopen-2019-001108"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_019","doi-asserted-by":"crossref","unstructured":"19. VANDER CRUYSSEN B, MU\u00d1OZ-GOMARIZ E, FONT P, JUAN M, KURT DE V, ANNEL\u0130ES B, et al. Hip involvement in ankylosing spondylitis: epidemiology and risk factors associated with hip replacement surgery. Rheumatology (Oxford) 2010;49(1):73\u201381.10.1093\/rheumatology\/kep17419605374","DOI":"10.1093\/rheumatology\/kep174"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_020","doi-asserted-by":"crossref","unstructured":"20. \u0130MKEREDEKER, JOHANNA CALLHOFF, FALK HOFFMANN, H\u0130LDRUN HA\u0130BEL, JOACH\u0130M S\u0130EPER, ANGELA Z\u0130NK, et al. Determinants of diagnostic delay in axial spondyloarthritis: an analysis based on linked claims and patient-reported survey data. Rheumatology (Oxford) 2019;58(9):1634\u201338.10.1093\/rheumatology\/kez09030903141","DOI":"10.1093\/rheumatology\/kez090"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_021","doi-asserted-by":"crossref","unstructured":"21. ABHIJEET DANVE, ATUL DEODLAR. Screening and referral for axial spondyloarthritis-need of the hour. Clin Rheumatol. 2015;34:987\u2013993.10.1007\/s10067-015-2958-225946983","DOI":"10.1007\/s10067-015-2958-2"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_022","doi-asserted-by":"crossref","unstructured":"22. DEODHAR A, MEASE PJ, REVEILLE JD, JEFFREY R CURT\u0130S, SU CHEN, KA\u0130LASH MALHOTRA, et al. Frequency axial spondyloarthritis diagnosis among patients seen by US rheumatologists for evaluation of chronic back pain. Arthritis Rheumatol. 2016;68(7):1669\u201376.10.1002\/art.39612509450026816002","DOI":"10.1002\/art.39612"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_023","doi-asserted-by":"crossref","unstructured":"23. BRAUN J, MOSCH T, FISCHER I, KILTZ U. Identification of patients with axial spondylarthritis in primary care (AWARE study). Z Rheumatol. 2019;78:569\u201376.10.1007\/s00393-018-0550-231375960","DOI":"10.1007\/s00393-018-0550-2"},{"key":"2026042915193744192_j_rjim-2021-0004_ref_024","doi-asserted-by":"crossref","unstructured":"24. OZAIR ABAWI, ROSALINE VAN DEN BERG, DESIREE VAN DEN HEIJDE, VAN GALEEN F. Evaluation of multiple referral strategies for axial spondyloarthritis in the SPondylo Arthritis Caught Early (SPACE) cohort. RMD open. 2017;3:e000389.10.1136\/rmdopen-2016-000389538802428469935","DOI":"10.1136\/rmdopen-2016-000389"}],"container-title":["Romanian Journal of Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/reference-global.com\/pdf\/10.2478\/rjim-2021-0004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T18:41:59Z","timestamp":1777488119000},"score":1,"resource":{"primary":{"URL":"https:\/\/reference-global.com\/article\/10.2478\/rjim-2021-0004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,26]]},"references-count":24,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,8,26]]},"published-print":{"date-parts":[[2021,9,1]]}},"alternative-id":["10.2478\/rjim-2021-0004"],"URL":"https:\/\/doi.org\/10.2478\/rjim-2021-0004","relation":{},"ISSN":["2501-062X"],"issn-type":[{"value":"2501-062X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,26]]}}}