Non-Urgent ED Utilization High For People With PsA, AS in Rural Areas

Victor Mocanu, MD

Credit: Research Gate

People with psoriatic arthritis (PsA) and ankylosing spondylitis (AS), particularly in rural settings, frequently utilized emergency departments (Eds) for less and non-urgent health concerns, highlighting the need for more accessible health services in these areas.¹

“Greater accessibility to ambulatory services may mitigate emergency department (ED) presentations for lower acuity issues. This study examined ED utilization patterns for individuals with PsA and ankylosing spondylitis AS in a universal access healthcare setting,” lead investigator Victor Mocanu, MD, Post-Graduate Medical Education, Cumming School of Medicine, University of Calgary, and colleagues wrote.¹

Mocanu and colleagues conducted a study using linked population-based administrative datasets in Alberta, Canada including data from 2008-2017 assessed for yearly ED visit frequency, timing, triage acuity, most responsible diagnoses, and disposition for persons with PsA and AS.

In total, the study included a total of 4,984 individuals with PsA and 14,690 with AS, who had 53,174 and 124,037 unique ED encounters, respectively. The investigators found that on average, 47.6% of persons with PsA and 35.7% with AS utilized the ED annually. Low acuity encounters, defined as less urgent or non-urgent, were common, and were responsible for 44.2% and 50.3% of visits for PsA and AS cohorts, respectively.¹

Mocanu and colleagues found that infection and injury were the most common responsible diagnoses. Only a small minority of patients with PsA (1.2%) or AS (2.0%) visited EDs for arthritis flares, with no significant differences by sex or urbanicity. Patients in rural areas had nearly twice the mean number of visits per year, had a higher frequency of less acute presentations, and were admitted less often in both disease cohorts. Between sexes, differences included differential timing of presentation to EDs, and females with PsA had a lower frequency of admission than males.¹

“ED use for less and non-urgent health concerns was frequent for persons with PsA and AS, particularly in rural settings. These data can inform tailored health service delivery including access solutions for persons residing in rural areas,” Mocanu and coleagues concluded.¹

Other recent research in PsA found that JAK inhibitor (JAKi) therapy was not associated with an increased risk of cardiovascular disease, venous thromboembolism (VTE), or some cancers in people with PsA and SpA compared to TNF inhibitors (TNFi) or IL-17 inhibitors (IL-17i).²

“Compared to TNFi, tofacitinib was shown to increase risk of CVD and cancer among people with rheumatoid arthritis (RA) with risk of CVD. Although JAKi are widely used in SpA, their safety profile remains unclear. Risk profiles may differ among SpA patients who are typically younger and have lower systemic inflammatory burden,” lead investigator Sizheng Steven Zhao, MBChB, PhD, Clinical Lecturer at the Centre for Musculoskeletal Research, University of Manchester, United Kingdom, and colleagues wrote.²

REFERENCES

1. Mocanu V, Barber CEH, McLane P, et al. Potentially Avoidable Emergency Department Utilization by Persons with Psoriatic Arthritis and Ankylosing Spondylitis: A Population-Based Cohort Study. J Rheumatol. 2025:52(1), jrheum.2024-1113; doi: 10.3899/jrheum.2024-1113

2. Zhao SS, Riley D, Austin P, Alam U. Comparative Safety of Jak Inhibitors Versus TNF or Il-17 Inhibitors for Cardiovascular Disease, Venous Thromboembolism and Cancer in Psoriatic Arthritis and Axial Spondyloarthritis. Ann. Rheumatic. Dis. 2024;83:352.