In psoriatic arthritis, diagnostic delays tied to worse outcomes

By Will Boggs MD

NEW YORK (Reuters Health) - Diagnostic delays are associated with poor radiographic and functional outcomes in patients with psoriatic arthritis (PsA), researchers from Ireland report.

"Early diagnosis and management is vital for good long-term outcomes," Dr. Muhammad Haroon from St. Vincent's University Hospital in Dublin told Reuters Health by email. "Our study has shown for the first time the long term adverse outcomes of delayed diagnosis of even 6 months in patients with psoriatic arthritis."

His recent study of psoriasis patients attending a dermatology clinic found that 29% had undiagnosed psoriatic arthritis. Until now, no study has addressed the outcomes of patients in whom there is a significant lag between symptom onset and rheumatological consultation.

Dr. Haroon and colleagues investigated 283 patients with psoriatic arthritis with a view to identifying characteristics that contribute to the delay in diagnosis of psoriatic arthritis and understanding the contribution of delayed diagnosis to outcomes.

The median lag time from disease onset to first rheumatological assessment was 1 year, and 30% (n=86) were seen within 6 months of symptom onset, according to the February 13 Annals of the Rheumatic Diseases online report.

Patients seen more than 6 months after symptom onset had significantly more erosions, osteolysis, sacroiliitis, arthritis mutilans, deformed joints, and treatment failures, based on univariate analysis. In this group, there were fewer drug-free remissions and worse functional disability scores, compared with patients seen within 6 months of symptom onset.

Results were similar for patients delayed beyond 1 and 2 years after symptom onset.

Delayed diagnoses beyond 2 years were associated with low education status and low body mass index, as well as worse physical component of quality of life.

"Patient education is key as regards the potential development of arthritis in patients with psoriasis," Dr. Haroon said. "Every psoriasis patient should be carefully evaluated for PsA."

"Patients with psoriasis are usually managed by general practitioners or by dermatologists, who rather than relying on patients' self-reported joint symptoms, should be more proactive in elucidating the appropriate musculoskeletal symptoms and signs," Dr. Haroon said. "Screening questionnaires have been developed as referral tools to help dermatologists and general practitioners identify suitable individuals for referral to rheumatologists."

"Although many public campaigns efforts exist for other chronic diseases, psoriatic arthritis, unfortunately, has not had similar attention," Dr. Haroon said. "There is significant lack of recognition at all levels - patients, primary care physicians, dermatologists, and government agencies."

SOURCE: http://bit.ly/PxprbH

Ann Rheum Dis 2014.

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