Improved Outcomes for Psoriatic Arthritis Patients with Less Than a Year Delay for Diagnosis

Selinde VJ Snoeck Henkemans, MD

Credit: Erasmus MC

A referral and diagnosis within a single year for psoriatic arthritis (PsA) patients is linked with improved clinical outcomes, according to new findings, indicating the existence of an ideal period for diagnosis.¹

These findings and others were the conclusion of a recent study conducted to evaluate the possibility of a window of opportunity for patients with PsA. The investigators sought to find out which characteristics of PsA patients are linked to longer delays in diagnosis.

This research was led by Selinde VJ Snoeck Henkemans, MD, of Erasmus MC Rheumatology in Rotterdam, the Netherlands. Henkemans and colleagues wrote that for patients with rheumatoid arthritis, there has been a well-established window of 12 weeks following onset of their symptoms, adding that such a window was not yet apparent for PsA patients.²

“Therefore, our aim is to first investigate whether a window of opportunity exists in PsA by comparing clinical (MDA and DAPSA) and patient-reported outcomes (PROs) in PsA patients with a short (<12 weeks), intermediate (12 weeks to 1 year) and long (>1 year) diagnostic delay,” Henkemans and colleagues wrote. “In addition, we examined which patient characteristics are associated with a longer diagnostic delay.”

Background and Methods

The investigators recruited individuals that had PsA diagnoses and had also not yet been given Disease-Modifying Antirheumatic Drugs (DMARDs) in the Dutch southwest Early Psoriatic Arthritis cohoRt (DEPAR) beginning in August 2013. The team established PsA diagnosis based upon the expert evaluations of rheumatologists.

Data used in this analysis was drawn up to March 2023, with the research team covering all consecutive individuals who had enrolled between 2013 - 2020. This ended up totaling 720 patients, and the team noted that 98% of the PsA patients had diagnostic delay information that was accessible for the study.

Newly diagnosed individuals with PsA were the main focus of the study, and they would not have begun DMARDs or had a follow-up meeting within at least 3 years within the Dutch southwest Early Psoriatic Arthritis cohoRt. The investigators ended up calculating the total delay of diagnosis, representing the time from patients’ symptom onset to diagnosis done by a rheumatologist, and then they segmented such delays into patient and clinician components.

The research team categorized the subjects’ total delay duration into periods known as short (<12 weeks), as intermediate (12 weeks - 1 year), or as long (>1 year). Such categories were then compared by the team as far as clinical outcomes such as Minimal Disease Activity (MDA) and Disease Activity index for Psoriatic Arthritis (DAPSA) remission.

The investigators also looked at patient-reported outcomes (PROs) over a 3-year follow-up period during their research.

Findings

Overall, the research team ended up looking at the data of 708 study participants with PsA, finding that 19% of these subjects were shown to have a short total delay, 33% were shown to have had an intermediate delay, and 47% were shown to have had a long delay in their receiving of PsA treatment. The team measured the delay at 1.0 month for patient delays and 4.5 months for clinician delays.

The team found that those shown to be in the short delay category were also found to be more likely to achieve Minimal Disease Activity (MDA) (OR 2.55, P = .003) and Disease Activity in Psoriatic Arthritis (DAPSA) remission (OR 2.35, P = 0.004) as opposed to the subjects with longer diagnosis delays.

Despite these findings, the investigators noted that PROs indicated the only numerical distinctions that were not statistically significant between the short and long delay cohorts of the study. The team also found that female subjects and subjects presenting with chronic back pain, enthesitis, or normal C-reactive protein levels were shown to have longer delays in their receiving of PsA treatment.

“In conclusion, a shorter time to PsA diagnosis is associated with a greater likelihood of achieving MDA and DAPSA remission over time, suggesting the presence of a window of opportunity in PsA,” they wrote. “This is an important finding because currently ~50% of PsA patients have a diagnostic delay of >1 year. Physician delay is modifiable and reduction of the physician delay is of utmost importance to improve long-term outcomes in PsA.”

References

1. ^{Snoeck Henkemans SVJ, de Jong PHP, Luime JJ, et alWindow of opportunity in psoriatic arthritis: the earlier the better?RMD Open 2024;10:e004062. Doi: 10.1136/rmdopen-2023-004062.}
2. ^{van der Linden MPM, le Cessie S, Raza K, et al. Long-term impact of delay in assessment of patients with early arthritis. Arthritis Rheum 2010;62:3537–46. doi:10.1002/art.27692.}