THE WINDOW OF OPPORTUNITY IN PSORIATIC ARTHRITIS: SIMILAR TO RHEUMATOID ARTHRITIS?
Authors: Snoeck Henkemans S et al.
The importance of early diagnosis and initiation of treatment, preferrable within 12 weeks after symptom onset, has been demonstrated in rheumatoid arthritis. In psoriatic arthritis, a diagnostic delay of up to 2 years is not uncommon.
The current analysis was performed to determine whether early (< 12 weeks), intermediate (12-52 weeks delay) or late diagnosis (> 52 weeks) has an impact on treatment outcome with regard to achievement of minimal disease activity (MDA). Total delay in diagnosis was then separated into patient and general practioner (GP) delay. The analysis was based on 855 DMARD naïve PsA patients who participated in the Dutch southwest Early PsA cohort (DEPAR).
Median total delay was 42 weeks with a significant delay due to the GP. PsA patients with > 52 weeks delay were more often female, had less swollen joints, more enthesitis and lower CRP and ESR. No significant differences in baseline parameters between early (< 12 weeks) and late diagnostic groups (12-52 weeks) were apparent. Patients with a diagnostic delay of more than 52 weeks were less likely to achieve MDA and DAPSA remission and had a worse HAQ over a 3 year time period compared to the other groups. All outcomes including radiographic progression were numerically better in the group of patients in whom PsA was diagnosed early (< 12 weeks) but this was not statistically significant.
This registry based analysis demonstrates, that a diagnostic delay in PsA is associated with worse outcome parameters. This fuels the notion that efforts should be undertaken to identify the obstacles for early referrals. It may be important to identify the reasons for diagnostic delays and to address them accordingly with the goal to improve outcome.