Accumulating data suggest that psoriatic arthritis (PsA) is underdiagnosed in primary care, and it can be difficult to distinguish from erosive osteoarthritis. Diagnostic delay in PsA is associated with poorer functional outcome despite treatment.
A recent national study from the UK assessed the delays in diagnosis of PsA compared with RA.
The researchers analyzed data from a national registry of early inflammatory arthritis that included 1016 patients with early PsA and matched them with a similar number of patients with RA (matched by age and sex).
The results found significant gaps in care between RA and PsA. The researchers reported that patients with PsA had a significantly longer delay to presentation and diagnosis than those with RA (29 vs. 21 weeks, respectively). A good EULAR response was seen in only 21.4% of PsA vs. 30.3% of RA patients. Difference were also noted in the pattern of DMARD treatment between PsA and RA. Despite similar disease activity and physical function at diagnosis, patients with PsA were less likely to receive combination DMARD treatment, and had increased disease burden at 3 months. Similar patterns and gaps in care have been previously described in Ontraio (Widdifield et al. CMAJ Open;4(2):E205-12).
In summary, the diagnosis of PsA can be challenging and may lead to significant delays in diagnosis. We need to focus our attention on this important gap in care of PsA and develop approaches to improve the early diagnosis of this disease.
Dr. Lihi Eder is an Assistant Professor of Medicine at the University of Toronto and Staff Rheumatologist and Director of the Psoriatic Arthritis Research Program at Women’s College Hospital. Dr. Eder is a Scientist at Women’s College Research Institute and associate member of the graduate faculty at the Institute of Medical Science.View Full Bio