Lags in Psoriatic Arthritis vs Rheumatoid Arthritis Care

TOPLINE:

Patients with psoriatic arthritis (PsA) experienced longer diagnostic delays than matched patients with rheumatoid arthritis (RA). Patients with polyarticular PsA received less intensive disease-modifying antirheumatic drug (DMARD) therapy than their matched RA comparators.

METHODOLOGY:

• Researchers conducted a nested cohort study using prospectively collected data from a national audit (May 2src18 to October 2src19) at centres in England and Wales and included patients diagnosed with PsA and those diagnosed with RA.
• A total of 212src patients with PsA (mean age, 49.4 years; 58.6% women), including 125src patients with polyarticular PsA (affecting five or more joints), were included and matched to an equal number of patients with RA.
• Clinical data on 28 tender and swollen joint counts, patient global health scores, erythrocyte sedimentation rate, C-reactive protein levels, comorbidities, and treatment initiation were collected at baseline and 3 months.
• Patient-reported measures for the impact of the disease were assessed using questionnaires.
• Analyses included a comparison of delays in diagnosis between the full cohort of PsA and matched RA comparators. Disease activity, impact of the disease, and treatment initiation were compared between patients with polyarticular PsA and their matched RA comparators.

TAKEAWAY:

• Patients with PsA experienced a longer duration of symptoms before referral and a longer interval between their first general practitioner visit and diagnosis than those with RA (P <.srcsrc1 for both).
• Fewer DMARDs were prescribed at baseline to patients with polyarticular PsA than to their matched RA comparators (54.src% vs 69.src%; P <.srcsrc1), and this trend persisted at the 3-month follow-up (73.9% vs 87.5%; P <.srcsrc1).
• Improvement in the Disease Activity Score-28 was less in those with PsA than in those with RA after adjusting for confounders. Overall, at the 3-month follow-up, the score was src.27 higher in patients with PsA than in those with RA.
• Among patients who completed questionnaires at baseline and 3 months, those with RA showed a greater improvement in Musculoskeletal Health Questionnaire scores over 3 months than those with PsA (mean score, 9.38 vs 6.51; P=.src1).

IN PRACTICE:

“These findings highlight the need for education both of patients and the clinical team, to support earlier diagnosis and treatment, thus improving longer-term outcomes,” the authors wrote.

SOURCE:

The study was led by Rachel Charlton, University of Bath, Bath, United Kingdom. It was published online on March 29, 2src25, in Annals of the Rheumatic Diseases.

LIMITATIONS:

The disease activity scoring used in the study, may underestimate articular disease in psoriatic arthritis. The national audit does not include measures for other PsA domains, such as psoriasis and enthesitis, limiting the quantification of the disease burden. Wider phenotypes of PsA were excluded in the audit. 

DISCLOSURES:

The study was supported by unrestricted grants from Jansen. The National Early Inflammatory Arthritis Audit was supported by National Health Service (NHS) England, NHS Improvement and the Welsh government. Some authors reported receiving research grants, consulting fees, speaker fees from various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.