Early Diagnosis Crucial for Better Outcomes in Psoriatic Arthritis - EMJ

Early Diagnosis Crucial for Better Outcomes in Psoriatic Arthritis

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A RECENT study highlights the importance of early diagnosis in psoriatic arthritis (PsA) patients, the study revealed that shorter delays between symptom onset and diagnosis lead to significantly better clinical outcomes. Psoriatic Arthritis, affecting many psoriasis patients, often goes undiagnosed due to the absence of specific antibodies and limited musculoskeletal expertise among primary care physicians and dermatologists. As such, delayed diagnosis can exceed one year, leading to increased joint damage and functional status.

The study aimed to identify if a potential “window of opportunity” exists for PsA patients, similar to rheumatoid arthritis, where early treatment significantly improves patient outcomes. And to determine characteristics associated with longer diagnostic delays. Researchers analysed data from the Dutch southwest Early PsA cohort, focusing on 708 newly diagnosed, disease-modifying antirheumatic drug-naïve PsA patients with at least three years of follow-up. The total diagnostic delay was measured from symptom onset to PsA diagnosis by a rheumatologist and categorised into short (<12 weeks), intermediate (12 weeks to 1 year), and long (>1 year) delays. Researchers then compared clinical outcomes, including Minimal Disease Activity (MDA) and Disease Activity Index for Psoriatic Arthritis (DAPSA) remission, across these groups.

Results showed that 19% of patients had a short delay, 33% had an intermediate delay, and 47% experienced a long delay. On average, patient delay was one month, while physician delay was 4.5 months. Patients diagnosed within a short delay (within 12 weeks) had a higher probability of achieving MDA and DAPSA remission over three years. Specifically, patients with a short delay were 2.55 times more likely to achieve MDA and 2.35 times more likely to reach DAPSA remission than patients with delays exceeding one year. Although patient-reported outcomes indicated numerical differences, these were not statistically significant between short and long-delay groups. The study also identified factors associated with longer delays: female patients, those presenting with enthesitis, chronic back pain, or normal C-reactive protein (CRP) levels were more likely to experience extended diagnostic periods.

These findings highlight the critical need for prompt referral and diagnosis in PsA, ideally within one year of symptom onset, to improve clinical outcomes. The researchers also suggest enhancing musculoskeletal training for primary care physicians and dermatologists, focusing on recognising less obvious symptoms like enthesitis. Since PsA patients with prompt diagnosis show significantly better outcomes, reducing physician delay could substantially benefit long-term patient health.

Kok MR et al. Window of opportunity in psoriatic arthritis: the earlier the better? RMD Open. 2024;10(1): e004062.



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