Tempo para o diagnóstico do Lúpus Eritematoso Sistêmico no Sistema Único de Saúde de Alagoas: uma análise de fatores de influência

Abstract

INTRODUCTION: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune inflammatory disease, characterized by immune dysregulation and the presence of autoantibodies that can affect multiple organs, potentially leading to irreversible damage. Delay in diagnosis confirmation and subsequent treatment initiation can result in higher rates of organ damage and increase the likelihood of irreversible complications. OBJECTIVE: To identify the average time interval (Δt) between the onset of symptoms of Systemic Lupus Erythematosus (SLE) and the definitive diagnosis of the disease; to identify factors contributing to the increase or decrease of this time interval. METHODS: Cross-sectional study conducted with individuals aged 18 years or older diagnosed with SLE at a rheumatology reference center within the public health system in Maceió. Time intervals between symptom onset and initial medical consultation, rheumatologist consultation, and diagnosis confirmation were evaluated, along with sociodemographic factors. The Systemic Lupus International Collaborating Clinics (SLICC) damage index was applied. RESULTS: The sample consisted of 160 lupus patients with a median age of 33.50 years. The average time between symptom onset and diagnosis was 6 months. Age was significantly associated with irreversible damage (p < 0.001; Effect size (95% CI): 0.42 (0.23 – 0.58)), indicating that older age increases the likelihood of irreversible damage. Education level was also significantly associated (p < 0.001; Effect size (95% CI): 0.46 (0.21 – 0.66)), with individuals with lower education tending to lack knowledge about SLE. The time between initial symptom onset and seeking the first medical consultation was less than 1 month; the median time between initial symptoms and rheumatologist consultation was 6 months; the median time between the first medical consultation and referral to the rheumatologist was 4 months; and the median time between initial symptom onset and treatment initiation was 7 months. The most frequently reported symptoms included arthralgia, alopecia, weight loss, arthritis, fever, asthenia, skin lesions, malar rash, and edema. General practitioners were the medical specialty most frequently referring patients to rheumatologists. CONCLUSION: The study found that the time between symptom onset and diagnostic confirmation was 6 months, which is shorter than the average reported in the literature (24 to 76.8 months). This could be attributed to the type of patients referred to the rheumatology service at Professor Alberto Antunes University Hospital or to improvements in primary care coverage in Brazil and increased healthcare professionals' knowledge about Lupus. The study also confirmed a positive correlation between diagnosis delay and presence of permanent damage, as previously established in the literature.