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Window of Opportunity in Psoriatic Arthritis

A Dutch Early Psoriatic Arthritis cohort study shows that psoriatic arthritis (PsA) patients treated early (referred and diagnosed  within in less than 12 weeks) had the best clinical outcomes. 

Early PsA cohort included 708 consecutive PsA patients categorized by treatment delay (time from symptom onset to PsA diagnosis by a rheumatologist). The total delay was categorised into short (<12 weeks), intermediate (12 weeks to 1 year) or long (>1 year). The diagnostic delay was correlated with rates of Minimal Disease Activity (MDA) and Disease Activity index for PSoriatic Arthritis (DAPSA) remission) and patient-reported outcomes during 3 years follow-up.

Among the 708 PsA patients, 136 (19%) had a short delay, 237 (33%) intermediate delay and 335 (47%) long total delay. 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 were also better, but not significant comparing the short and long delay groups. 

Longer delays were more likely inwomen and those presenting with enthesitis, chronic back pain or normal C-reactive protein (CRP).

A focus on earlier referral and diagnosis, especially in women or those with enthesitis or chronic low back pain, will significantly improve PsA outcomes. This data supports the concept of a window of opportunity in PsA.


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The author has no conflicts of interest to disclose related to this subject