AB0789 The psoriatic arthritis patient's journey: special emphasis on diagnosis and treatment delays

Abstract

BackgroundA delay in diagnosis and treatment of Psoriatic Arthritis (PsA) is associated with increased disability and damage in the long term. There is currently scarce data available about diagnosis delay, referrals delays, and time to first treatment in patients with PsA in developing countries.ObjectivesTo describe the journey of patients with psoriatic arthritis, with special emphasis on diagnosis and treatment delays.MethodsAll patients with PsA registered in the Rheumatology Unit data base (between 2000–2016), with complete data, were included. Electronic medical records were manually revised, and the following data were obtained: date of first visit to a Dermatologists due to Psoriasis (PsO) symptoms, date of PsO diagnosis, date and type of first musculoskeletal symptom, specialty of physician seen at first visit for musculoskeletal symptoms, date of PsA diagnosis, date and reason for prescription of first Disease Modifying anti-Rheumatic Drug (DMARD). Primary outcome variable was mean lag time between first musculoskeletal symptom and diagnosis of PsA. Other variables calculated were: mean lag time between first musculoskeletal symptom and first physician encounter because of those symptoms, mean lag time to first DMARD and mean lag time between PsO diagnosis and PsA diagnosis. Variables associated with a delay in PsA diagnosis (more than one year delay) were analyzed in multivariable analysis (logistic regression).Results93 patients were included, mean age 60.8 years (SD: 15.3), 61% males. Mean age at time of PsA diagnosis was 52 years (SD: 14.8). The most common musculoskeletal symptom was arthralgia (46%), followed by arthritis (37%), enthesitis (6%), low back pain (6%), and dactylitis (4%). Mean lag time between first musculoskeletal symptoms and visit to a physician because of those symptoms was 16,8 months (SD: 44,4) (median: 1,92 (IQR: 0,35–11,6). In Only 33% of the cases the first specialist seen was a Rheumatologist. Mean lag time between first musculoskeletal symptom and diagnosis of PsA was 19,2 (SD: 28,8) months (Median: 7,2 (IQR: 2,4–21,6 months). In 90 patients (97%), the diagnosis of PsO preceded the diagnosis of PsA, a mean time of 15.1 years (SD: 14.4). 83 patients (89%) received traditional DMARDs, 82% because of the musculoskeletal symptoms, with a mean lag time between PsA diagnosis and initiation of DMARDs of 11,4 months (SD: 31,2) (Median: 0,48 (IQR: 0–4,3) months). Forty-three patients (46.2%) had a delay on PsA diagnosis equal or greater than 1 year. In logistic regression analysis, including age, sex, first specialist seen and type of musculoskeletal symptom, none was independently associated with a delay equal or greater than 1 year in PsA diagnosis.ConclusionsMean time between symptoms' onset and PsA diagnosis was relatively short. However, a delay greater that one year was observed in almost half of patients. As none of the variables studied was associated with a delay in diagnosis, more studies are needed to identify potential actions that would help reducing this delay.Referen...

Epidemiology and Treatment of Patients with Rheumatoid Arthritis, Psoriatic Arthritis and Psoriasis in Germany: A Real-World Evidence Study

“…This is supported by a recent report for RA patients that highlighted that the mean duration from first disease symptom to rheumatologist consultation was 9.2 months, while the mean time to RA diagnosis was 14.2 months [33]. A similar study found that a delay in PsA diagnosis was greater than one year in nearly half of the patients [34]. The majority of patients with RA received treatment prescribed by a rheumatologist but treatment initiation was also found to be delayed (mean duration from first disease symptom of 16.9 months) [33].…”

“…For patients with PSO it is interesting that while the majority of patients are not treated systemically, among those that are treated with a biologic more than half received above-label dosing (53.9%). Delayed PsA diagnosis, which was highlighted in a recent report [ 34 ], is likely a contributing factor to patients not receiving treatment.…”