Factors Associated with Delay in the Diagnosis and Treatment of Systemic Lupus Erythematosus in Adult Patients: A Systematic Review

Objectives: To develop a systematic review of quantitative studies focused onidentifying factors associated with delay in diagnosing and treating adult patients withsystemic lupus erythematosus (SLE).Methods: Electronic searches were conducted in Scopus, PubMed, and Web ofScience for studies published up to July 15, 2024. Inclusion criteria were studies inadult patients that estimated delay in diagnosis and/or treatment, and associatedbarriers and facilitators. The Joanna Briggs Institute (JBI) Checklist was used toassess quality.Results: A total of 25 studies were included. The estimated median delay indiagnosis was 18 months (IQR 0-32.3), and time-to-treatment from diagnosis was2.09 months (IQR 0.0-5.05). The median delay in diagnosis was 14.09 months (IQR0.0-18.5) in men and 29.55 months (IQR 1.1-144.0) in women (n=5). Early-onsetSLE had a median delay of 3.88 months (IQR 1.5-9.1), while late-onset SLE was10.10 months (IQR 3.0-38.0) (n=3). The barriers identified were the number ofphysicians consulted, misdiagnoses, lack of prompt access to a specialist, and lackof 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. Thereported median delays in the diagnosis and treatment of SLE are 18 months and2.09 months. There is no consensus on defining diagnosis and/or treatment in SLEpatients or a unified estimation method.