Delayed diagnosis of axial spondyloarthritis (axSpA) continues to be an issue for many patients, particularly women, the Irish Society for Rheumatology (ISR) 2026 Spring Meeting was told.
Dr Sinead Maguire, Consultant Rheumatologist, Our Lady’s Hospital, Navan, Co Meath, gave a presentation focusing on the challenges in the imaging and diagnosis of axSpA.
AxSpA diagnosis remains challenging, with an average delay in diagnosis ranging from seven to 10 years. Timely diagnosis is key to avoid irreversible structural changes, pain, and loss of function, she maintained.
The diagnosis of axSpA should be based on a combination of symptoms assessed through thorough clinical history, physical examination, laboratory investigations, and imaging. The Assessment of SpondyloArthritis international Society have developed classification criteria for axSpA, and she also discussed the use of the modified New York criteria.
However, axSpA can still be difficult to diagnose, particularly where mechanical changes or inflammatory patterns are unclear, Dr Maguire noted.
She explained that MRI can be very beneficial in the early detection of axSpA, helping identify active inflammation, and support diagnosis in uncertain cases. It is therefore being increasingly relied on in clinical practice.
However, long waiting times for diagnostics are a reality in the public health system, so the wait for an MRI can actually contribute to a delay in diagnosis of axSpA. As a result, clinical history and examination are key and treatment should commence while waiting for imaging confirmation, Dr Maguire maintained.
“Oftentimes, when I am waiting for an MRI, I treat them as if they have axSpA, and it is also a good test to see how do they respond to NSAIDs [non-steroidal anti-inflammatory drugs], how do they respond to physiotherapy, presuming they are suitable for those interventions …. And that further increases their diagnostic certainty,” she told the Medical Independent.
“I would do everything short of starting a biologic, so see what their response is. Sometimes over time their symptoms evolve to a more inflammatory or mechanical pattern, which helps as well.”
In addition, while MRIs are being ordered earlier and more frequently in patients with mechanical back pain, meaning more abnormalities are being detected in the sacroiliac joint, not all of them represent axSpA and bone marrow oedema is not specific, Dr Maguire noted.
“The challenge is distinguishing these inflammatory changes from mechanical mimics in the right clinical context…. So the biggest issue is making sure to look at the images yourself. If the images aren’t fitting with the clinical context, go back and look at the history and review them.”
During the question-and-answer session, many ISR audience members agreed with Dr Maguire’s points that more needs to be done to address the issue of late diagnosis of axSpA. One doctor said that many women are told they have fibromyalgia when it is actually axSpA.
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