Greater Diagnostic Delays Observed in PsA Compared with RA

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Results of a monocentric, single-center, cross-sectional study revealed greater diagnostic delays in patients with psoriatic arthritis (PsA) compared with rheumatoid arthritis (RA), in seronegative RA, in patients who were not diagnosed by a rheumatologist, those who were previously misdiagnosed, and among patients residing in small-to-medium cities, according to research published in Reumatismo.¹

Both PsA and RA are inflammatory rheumatic diseases which can lead to erosive damage of the joints and functional impairment. These conditions are often linked to reduced quality of life as well as a variety of comorbidities, including metabolic, cardiovascular, and psychiatric diseases.²

“Benefits deriving from setting up therapies aimed at achieving a specific target (treat-to-target) and from tight and periodic monitoring of disease activity (tight control) are well known to reach better long-term outcomes and achieve ambitious results such as early remission or low disease activity,” wrote a group of investigators from Tor Vergata University in Rome, Italy. “Therefore, early diagnosis is essential.”

Investigators recruited adult patients with PsA and RA living in the Lazio region of Italy to evaluate the factors related to a diagnostic delay and accessibility to treatment among this patient population. Information collected included treatment initiation, time between symptom onset, diagnosis, serological data, and clinical data, such as age, sex, and any family history of PsA or RA. Other pertinent information included any previous misdiagnoses, residence, the type of physician who made the initial diagnosis, and any referral to a rheumatologic center.

In total, 100 patients with RA (77 females and 23 males) and 100 patients with PsA (65 females and 35 males) were recruited into the study. In the RA cohort, the mean age was 61.3 years compared with 55 years in the PsA cohort. Most (68%) patients with PsA had concomitant psoriasis and approximately 6 out of 10 patients with RA were seropositive. Half of patients with RA and PsA lived in small cities (53% and 54%, respectively).

Compared with RA, patients with PsA had a higher diagnostic delay (P = .003) and a greater time between the onset of symptoms and the start of treatment (P = .006). However, a delayed initiation of a second-line treatment was higher in patients with RA compared with PsA (P = .0007). Patients with PsA also reported delays in starting treatment with a targeted synthetic disease-modifying antirheumatic drug (tsDMARD) compared with the RA group (P = .0004).

Both groups experienced a higher diagnostic delay (P = .02) and a greater time between symptom onset and the initiation of a conventional synthetic disease-modifying antirheumatic drug (csDMARD) for those who lived in small-to-medium-sized cities (P = .02).

Patients who were diagnosed by a primary care physician, as opposed to a rheumatologist, were more likely to experience diagnostic delay (P = .034) and a delayed start of first-line therapy (P = .019). Similarly, patients with RA and PsA who were initially misdiagnosed had a greater diagnostic delay (P = .03 and P = .003, respectively) as well as delays in receiving csDMARDs (P = .05 and P = .01, respectively) compared with those who were accurately diagnosed the first time.

Compared with patients with seropositive RA, those who were seronegative experienced delays in both diagnosis (P = .02) and treatment initiation (P = .03).

Investigators noted the relatively small sample size and retrospective data collection as limitations of the study.

“This study analyzed the main factors related to diagnostic delay in RA and PsA, which still appeared to be significant,” investigators concluded. “This confirmed the need to improve physicians’ information and the collaboration between different specialists to guarantee an appropriate and prompt referral for early diagnosis and related therapeutic management.”

References

1. ^{Iacovantuono M, Ferrigno S, Conigliaro P, et al. Evaluation of diagnostic and therapeutic delay in patients with rheumatoid arthritis and psoriatic arthritis. Reumatismo. 2024;76(1):10.4081/reumatismo.2024.1607. Published 2024 Mar 22. doi:10.4081/reumatismo.2024.1607}
2. ^{Gottlieb AB, Dann F. Comorbidities in patients with psoriasis. Am J Med 2009; 122: 1150.e1-9.}