Diagnostic Delays and Clinical Presentation of Systemic Lupus Erythematosus: A Single-centre Study in the Eastern Region

Abstract Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with diverse clinical features that cause delayed diagnosis. This research investigates SLE patient clinical features as well as elements that may extend the time needed for proper diagnosis. Objective: Our primary goal in this study is to assess patient characteristics and clinical situation at disease onset and its influence on the time of diagnosis. Materials and Methods: This retrospective cross-sectional study was conducted at King Fahd Hospital of the University in Khobar, Saudi Arabia. The study included adult SLE patients diagnosed according to the European League Against Rheumatism and the American College of Rheumatology 2019 criteria. Results: This study included 109 patients, with the majority being female ( n = 103, 94.5%) and Saudi nationals ( n = 101, 92.7%). The most common initial symptom was synovitis or tenderness in at least two joints ( n = 41, 37.6%), followed by fever and acute cutaneous lupus ( n = 12, 11.0% each). The median time from symptom onset to the first physician visit (Lag 1) was 3 weeks, while the mean time from the first physician visit to rheumatology consultation (Lag 2) was 44.15 weeks. A significant proportion of patients ( n = 36, 33.0%) consulted five or more physicians before receiving a confirmed diagnosis. Laboratory findings showed low C3 levels in 40 patients (36.7%), low C4 in 31 patients (28.4%) and positive anti-dsDNA in 29 patients (26.6%). Conclusion: In this study, diagnosis of SLE is delayed because of physician misdiagnosis and unnecessary referral periods. The two key steps needed to shorten diagnostic delays include better physician awareness and better patient referral systems.