Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis

Abstract

Objectives(1) To investigate the demographic and clinical characteristics contributing to the delay from symptom onset to the first visit to a rheumatologist; (2) to compare clinical, radiographic and patient-reported outcome measures of those who saw a rheumatologist early in their disease course with those who were diagnosed later.MethodsAll psoriatic arthritis (PsA) patients, fulfilling CASPAR criteria, with an average disease duration of >10 years were invited for detailed clinical evaluation. The total lag time from symptom onset to their first rheumatological encounter was studied. The data were extracted from the referral letters and medical records. Patients were classified as early consulters or late consulters depending on whether they were seen by a rheumatologist within or beyond 6 months of symptom onset.Results283 PsA patients were studied. Median lag time from the disease onset to the first rheumatological assessment of the cohort was 1.00 years (IQR 0.5–2). 30% (n=86), 53% (n=149) and 71% (n=202) of the cohort were seen by a rheumatologist within 6 months, 1 and 2 years of symptom onset, respectively. PsA patients with low education status (OR 2.09, p=0.02) and Body Mass Index (OR 0.92, p=0.01) were significantly more likely to have a diagnostic delay of >2 years. On multiple stepwise regression analysis, the model predicted significant association of late consulters with the development of peripheral joint erosions (OR 4.25, p=0.001) and worse Health Assessment Questionnaire scores (OR 2.2, p=0.004).ConclusionsEven a 6-month delay from symptom onset to the first visit with a rheumatologist contributes to the development of peripheral joint erosions and worse long-term physical function.

Promoting patient‐centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience

“…Furthermore, early diagnosis and treatment of PsA with a DMARD may reduce joint damage compared with later initiation of treatment;22 better outcomes have been associated with initiation of therapy within 2 years of onset of PsA, compared with 2 years after onset 46…”

Improving the Management of Psoriatic Arthritis and Axial Spondyloarthritis: Roundtable Discussions with Healthcare Professionals and Patients

“…There is some evidence to suggest that earlier treatment in the disease course is associated with better outcomes [26][27][28] and, conversely, when diagnosis is delayed, clinical outcomes are negatively affected [29,30]. In AS, a study of 334 patients demonstrated that a delay of more than 10 years before starting anti-TNF therapy resulted in an increase in the likelihood of structural damage, compared with those who had a delay in treatment of at most 10 years [31].…”

Incidence of Psoriatic Arthritis in Russia: Trends at the Present Stage and Prospects

“…Одним из простых и доступных способов выявления ПсА у больных псориазом считают применение скри-нинговых опросников, которые помогают заподозрить ПсА и своевременно направить пациента на консульта-цию к ревматологу [18]. Это представляется очень важ-ным, так как задержка в обращении к специалисту-рев-матологу даже на 6 мес является самостоятельным фак-тором риска для возникновения в дальнейшем эрозий в суставах, сакроилиита и функциональных нарушений [19,20]. Поэтому диагностика и лечение ПсA должны проходить в тесном сотрудничестве дерматовенерологов и ревматологов.…”