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PsA diagnosis often delayed in dermatology vs. rheumatology

In the dermatology setting, researchers found a substantial delay from symptom onset to a psoriatic arthritis diagnosis compared with rheumatology, according to LOOP, a multicenter study across 44 sites in the U.S.

“This may be because rheumatologists are more familiar with the joint-related symptoms associated with PsA, which have some similarities with those observed in other forms of arthritis such as rheumatoid arthritis,” Philip J. Mease, MD, clinical professor at University of Washington and director of rheumatology research at Swedish Medical Center, Seattle, and colleagues wrote.

Five hundred thirteen patients with a confirmed diagnosis of PsA were included in the study; 71.3% of patients were recruited by rheumatologists and 28.7% by dermatologists.

Overall, disease activity and burden were similar across both specialties. Among the entire population, median time from symptom onset to diagnosis was 1.2 years; 31.8% of patients waited more than 4 years for a diagnosis.

Two hundred eighty-two patients received conventional synthetic disease-modifying antirheumatic drugs, and 354 received biologic disease-modifying antirheumatic drugs.

Sixty-three percent of patients with a confirmed diagnosis of PsA first presented with skin symptoms, 21.1% with simultaneous skin and joint symptoms, and 14.2% with joint symptoms. Those presenting with joint symptoms first had a longer median time to diagnosis, 3.32 years.

Patients enrolled by rheumatologists had a shorter median time from symptom onset to PsA diagnosis compared with those enrolled by dermatologists (1 year vs. 2.6 years; HR = 1.47; 95% CI, 1.20-1.78).

Patients enrolled by dermatologists had significantly higher skin scores determined by Body Surface Area and Psoriasis Area and Severity Index, higher enthesitis scores via Leeds Enthesitis Index and worse quality of life via Dermatology Life Quality Index.

Additionally, patients in western areas of the U.S. experienced less severe disease via joint involvement, enthesitis and dactylitis than those in central or eastern areas.

“Clinical specialty setting and geographic region can affect the timing and choice of disease management steps as well as disease activity and disease burden in patients with PsA in the USA,” Mease and colleagues wrote. – by Abigail Sutton

Disclosures: Mease reports he received research grants, consulting fees and/or speaker fees from AbbVie, Amgen, Bristol-Myers Squibb, Celgene, Galapagos, Genentech, Gilead, Janssen, Lilly, Novartis, Pfizer, Sun Pharma and UCB. Please see the study for all other authors’ relevant financial disclosures.