Disclosures: The researchers report support from the Rochester Epidemiology Project. Karmacharya reports a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Please see the study for all other authors’ relevant financial disclosures.
March 03, 2021
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Two-year delay in diagnosis common for patients with psoriatic arthritis

Disclosures: The researchers report support from the Rochester Epidemiology Project. Karmacharya reports a grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Please see the study for all other authors’ relevant financial disclosures.
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More than half of patients with psoriatic arthritis experience a two-year delay from symptom onset to diagnosis, especially younger patients, those who are obese and those with enthesitis, noted data published in The Journal of Rheumatology.

“Delays in diagnosis leads to poor outcomes in rheumatologic diseases,” Paras Karmacharya, MBBS, at Mayo Clinic College of Medicine, told Healio Rheumatology. “In PsA, even a delay of 6 to 12 months has been shown to be associated with joint damage and poor functional outcomes. Also, treatment response may be better in early PsA. Despite these benefits of early diagnosis, the majority of patients have significant delays in diagnosis of PsA — up to 40% have not been previously identified in screening studies.”

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“Only a few studies have examined delay in diagnosis of PsA, or the trends in diagnostic delay of PsA in the United States,” he added. “The factors associated with delay in diagnosis have not been well-studied. The lack of longitudinal, population-based PsA cohorts in the United States has made this type of study difficult.”

To analyze the demographic and clinical factors associated with diagnostic delay in patients with PsA, Karmacharya and colleagues conducted a retrospective study of a population-based cohort from Olmsted County, Minnesota. This cohort included 164 patients with incident PsA from 2000 to 2017, all of whom met the Classification of Psoriatic Arthritis (CASPAR) criteria for the disease. The mean age was 41.5 years.

Paras Karmacharya

For their study, the researchers defined diagnostic delay as the time from any patient-reported, PsA-related joint symptom to a physician diagnosis of PsA. They then used logistic regression models to identify factors associated with any delay in PsA diagnosis.

According to the researchers, the median time from symptom onset to physician diagnosis was 2.5 years, with an interquartile range of 0.5 to 7.3. At 6 months, 23% of patients had received a diagnosis of PsA. By 1 year, 35% had a diagnosis. Two years after symptom onset, only 45% had been diagnosed. There was no significant trend in diagnostic delay over calendar time.

Earlier age at symptom onset, higher BMI and enthesitis were associated with a diagnostic delay of more than 2 years. Meanwhile, sebopsoriasis was associated with a lower likelihood of delay.

“Despite recent advancements in diagnostics, this delay has not significantly improved in the United States,” Karmacharya said. “In our study, patients with younger age at onset of arthritis symptoms, those who were obese, or had enthesitis were more likely to have a delayed diagnosis. Younger patients are more likely to dismiss their symptoms, not report joint symptoms or be aware of joint inflammation. Also, enthesitis may be attributed to overuse and trauma by the patients and general practitioners and is not a common symptom of inflammatory arthritis such as rheumatoid arthritis.”

“Similarly, obese patients often have other joint conditions which could potentially explain their joint symptoms, such as osteoarthritis or gout,” he added. “Therefore, the joint symptoms might be dismissed in these cases. If anyone with psoriasis develops joint or entheseal pain, they should seek appropriate care and PsA should be ruled out.”