Factors associated with delay in the diagnosis and treatment of systemic lupus erythematosus in adult patients: a systematic review

Abstract Objectives To develop a systematic review of quantitative studies focused on identifying factors associated with delay in diagnosing and treating adult patients with systemic lupus erythematosus (SLE). Methods Electronic searches were conducted in Scopus, PubMed, and Web of Science for studies published up to July 15, 2024. Inclusion criteria were studies in adult patients that estimated delay in diagnosis and/or treatment, and associated barriers and facilitators. The Joanna Briggs Institute (JBI) Checklist was used to assess quality. Results A total of 25 studies were included. The estimated median delay in diagnosis was 18 months (IQR 0-32.3), and time-to-treatment from diagnosis was 2.09 months (IQR 0.0-5.05). The median delay in diagnosis was 14.09 months (IQR 0.0-18.5) in men and 29.55 months (IQR 1.1-144.0) in women (n = 5). Early-onset SLE had a median delay of 3.88 months (IQR 1.5-9.1), while late-onset SLE was 10.10 months (IQR 3.0-38.0) (n = 3). The barriers identified were the number of physicians consulted, misdiagnoses, lack of prompt access to a specialist, and lack of knowledge of the disease. The average quality was 6.4. Conclusion The factors associated with diagnostic delay were being female, White, or of Multiple races, having a less severe disease presentation, and older age. The reported median delays in the diagnosis and treatment of SLE are 18 months and 2.09 months. There is no consensus on defining diagnosis and/or treatment in SLE patients or a unified estimation method.