Diagnostic Delay in Psoriatic Arthritis: A Population Based Study.

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To examine demographic and clinical characteristics associated with diagnostic delay in psoriatic arthritis (PsA).We characterized a retrospective, population-based cohort of incident adult (≥18 years) PsA patients from Olmsted County, MN from 2000-17. All patients met classification criteria. Diagnostic delay was defined as the time from any patient-reported PsA-related joint symptom to a physician diagnosis of PsA. Factors associated with delay in PsA diagnosis were identified through logistic regression models.Of the 164 incident PsA cases from 2000-17, 162 had a physician or rheumatologist diagnosis. Mean (SD) age was 41.5 (12.6) and 46% were females. Median time from symptom onset to physician diagnosis was 2.5 years (interquartile range: 0.5 to 7.3). By six months, 38 (23%) received a diagnosis of PsA, 56 (35%) by one year and 73 (45%) by two years after symptom onset. No significant trend in diagnostic delay was observed over calendar time. Earlier age at onset of PsA symptoms, higher body mass index, and enthesitis were associated with a diagnostic delay of >2 years, while sebopsoriasis was associated with a lower likelihood of delay.In our study, more than half of PsA patients had a diagnostic delay of >2 years, and no significant improvement in time to diagnosis was noted between 2000-17. Patients with younger age at PsA symptom onset, higher BMI, or enthesitis before diagnosis were more likely to have a diagnostic delay of >2 year while patients with sebopsoriasis were less likely to have a diagnostic delay.

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Authors: Paras Karmacharya, Kerry Wright, Sara J Achenbach, Delamo Bekele, Cynthia S Crowson, Alexis Ogdie, Alí Duarte-García, Floranne C Ernste, Megha M Tollefson, John M Davis


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