Window of opportunity in psoriatic arthritis: The earlier the better?

Selinde V.J. Snoeck Henkemans*, Pascal H.P. De Jong, Jolanda J. Luime, Marc R. Kok, Ilja Tchetverikov, Lindy Anne Korswagen, Sjoerd M. Van Der Kooij, Maikel Van Oosterhout, Paul Baudoin, Jessica Bijsterbosch, Jos H. Van Der Kaap, Annette H.M. Van Der Helm-Van Mil, Marijn Vis

*Corresponding author for this work

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Abstract

Objectives To investigate whether there is a window of opportunity for psoriatic arthritis (PsA) patients and to assess which patient characteristics are associated with a longer diagnostic delay. Methods All newly diagnosed, disease-modifying antirheumatic drug-naïve PsA patients who participated in the Dutch southwest Early PsA cohoRt and had ≥3 years of follow-up were studied. First, total delay was calculated as the time period between symptom onset and PsA diagnosis made by a rheumatologist and then split into patient and physician delays. The total delay was categorised into short (<12 weeks), intermediate (12 weeks to 1 year) or long (>1 year). These groups were compared on clinical (Minimal Disease Activity (MDA) and Disease Activity index for PSoriatic Arthritis (DAPSA) remission) and patient-reported outcomes during 3 years follow-up. Results 708 PsA patients were studied of whom 136 (19%), 237 (33%) and 335 (47%) had a short, intermediate and long total delay, respectively. Patient delay was 1.0 month and physician delay was 4.5 months. Patients with a short delay were more likely to achieve MDA (OR 2.55, p=0.003) and DAPSA remission (OR 2.35,p=0.004) compared with PsA patients with a long delay. Patient-reported outcomes showed numerical but non-significant differences between the short and long delay groups. Female patients and those presenting with enthesitis, chronic back pain or normal C-reactive protein (CRP) had a longer delay. Conclusions In PsA, referral and diagnosis within 1 year is associated with better clinical outcomes, suggesting the presence of a window of opportunity. The most gain in referral could be obtained in physician delay and in females, patients with enthesitis, chronic back pain or normal CRP.

Original languageEnglish
Article numbere004062
JournalRMD Open
Volume10
Issue number1
DOIs
Publication statusPublished - 27 Feb 2024

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