Two-thirds of patients with PsA waited 6 months or more for diagnosis
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Approximately 66% of adults with psoriatic arthritis waited 6 months or more for their diagnosis after first seeking medical attention, with about 32.5% waiting 5 years or more, according survey findings published in BMC Rheumatology.
“Early diagnosis of PsA is important because a delayed diagnosis significantly contributes to negative patient outcomes,” Alexis Ogdie, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote. “Patients with untreated PsA, even with a 6-month delay from symptom onset to the first rheumatology visit, may develop peripheral joint erosions, progressive joint damage and severe physical limitations.”
“Most patients initially seek medical care from general practitioners; however, patients in consultation with a general practitioner may not receive a timely diagnosis of PsA because it may be challenging for nonrheumatologists to distinguish PsA from other forms of arthritis,” they added. “Estimates indicate that 6% to 42% of patients with psoriasis eventually develop PsA. There is limited information on the real-world, diagnostic experiences of patients with PsA, including medical care sought and potential barriers to diagnosis.”
To analyze the patient experience of receiving a diagnosis of PsA, Ogdie and colleagues conducted a study in two phases. First, the researchers conducted a targeted literature review, as well as qualitative telephone interviews with clinical experts and adults diagnosed with PsA. From this research, Ogie and colleagues identified key concepts associated with disease burden and treatment experience, which were then used to draft an online survey that would become the basis of the study’s second phase.
That survey — a 42-item, cross-sectional, web-based questionnaire — collected sociodemographic data, clinical symptoms, disease burden and diagnosis history. Adult participants with a self-reported diagnosis of PsA were recruited through the patient support community at Creaky Joints, as well as the online patient research registry at Arthritis Power and outreach through social media. A total of 203 respondents completed the survey between Sept. 5 and Oct. 13, 2017.
According to the researchers, the time between seeking medical attention and receiving a diagnosis was less than6months for 69 respondents, or about 33.99% of the total; 6months to 4years for 68 respondents, or 33.5%; and5 or moreyears for 66 respondents, or 32.51%. Among the total, 79.8% sought care from general practitioners, and 66.5% presented at some points to rheumatologists.
The most common symptoms that led patients to seek medical care were joint pain, identified by 70% of respondents, and stiffness, identified by 53.7%. Among the initial symptoms that led respondents to seek care, joint pain, swollen joints and “sausage-like fingers or toes” were more common among those with a shorter time to diagnosis. Stiffness, fatigue, enthesitis and back pain were more common among patients who waited longer.
The most common misdiagnoses were psychosomatic issues and osteoarthritis. Patients with shorter wait times for a diagnosis experienced lower frequencies of misdiagnosis.
“Our study showed that many people living with PsA faced a winding path to arrive at a diagnosis, migrating through various types of health care providers prior to the diagnosis,” Ogdie and colleagues wrote. “Respondents with shorter times to diagnosis tended to seek care from dermatologists and rheumatologists. Many respondents encountered substantial delays and misdiagnoses before finally receiving a PsA diagnosis. Differences in presenting symptoms may have played a role in time to diagnosis.”
“Symptom differences such as enthesitis and stiffness were observed among respondents with shorter vs. longer time to diagnosis,” they added. “Increased recognition of heterogeneous symptoms associated with PsA, as well as understanding existing diagnostic barriers, may lead to prompt diagnosis and initiation of appropriate treatment that may improve outcomes.” – by Jason Laday
Disclosure: Ogdie reports consulting fees from AbbVie, Amgen, BMS, Celgene, Eli Lilly, Novartis, Pfizer and Takeda, as well as has grant support from the NIH, the Rheumatology Research Foundation, Pfizer and Novartis. Please see the study for all other authors’ relevant financial disclosures.
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