Clinical Profile for Diagnostic Delay in Psoriatic Arthritis Points to Females, Enthesitis

R arthritis
R arthritis
Several recent studies have shown that a delay in diagnosis of PsA leads to a worse outcome.

WASHINGTON, DC—Is there a clinical profile for patients with psoriatic arthritis (PsA) with a diagnostic delay? That’s the question Marijn Vis, MD, PhD, a rheumatologist at Erasmus Medical Centre in Rotterdam, The Netherlands, and colleagues sought to answer using a registry from 8 hospitals, the results of which were presented at the 2016 ACR/ARHP Annual Meeting.

Several recent studies have shown that a delay in diagnosis of PsA leads to a worse outcome, with a delay of more than 6 months from symptom onset contributing to the development of erosions and worse long-term physical function.

In investigating the profile of patients with a diagnostic delay, the study found those with longer than 6 months delay were more likely to be female and more frequently have enthesitis. 

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Data for August 2013 to March 2016 were reviewed for 316 incident patients with PsA from the Dutch South-West Psoriatic Arthritis Registry (DEPAR), which includes patients with newly diagnosed PsA. During the first year, patients are followed every 3 months. PsA core measurements collected included swollen and tender join count (66/68), enthesitis (LEI and MASES), dactylitis (LDI), and psoriasis (PASI).

Quality of life (SF-36) and health (HAQ) measures were also assessed. Groups with symptom duration of longer and shorter than 6 months were compared using parametric and non-parametric tests.

The average age of the patients was 50.4 years (SD 13.7) and 50% were male. Median duration of time from symptom complaints to diagnosis was 11.6 months (range 0–586 days), and median time from first general practitioner visit to diagnosis was 4.4 months (range 0–374 days).

At baseline, patients with symptom duration shorter than 6 months were slightly older (52.7 (SD 14.6) vs. 49.1 (SD 13.3) years; P<0.05), more frequently male (60% vs. 40%, P<0.05) and had less enthesitis (39% vs. 52%; P<0.05). No difference in other disease features or quality of life or health was observed.

As shown by lower psoriatic arthritis disease activity score (PASDAS) and composite psoriatic disease activity index (CPDAI scores at 3 and 6 months, patients with a symptom duration of less than 6 months seemed to have a better response to treatment.