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Window of Opportunity in Psoriatic Arthritis

The Dutch southwest Early psoriatic arthritis (PsA) cohort study has demonstrated that the earlier the referral and diagnosis of PsA, the better the outcome. 

The study included newly diagnosed, DMARD naive PsA patients who were followed for ≥3 years. Key time intervals were calculated as the total delay (from symptom onset to PsA diagnosis made by a rheumatologist) and further split into patient and physician delays. Delays were categorised into short (<12 weeks), intermediate (12 weeks to 1 year) or long (>1 year). PsA outcomes included Minimal Disease Activity (MDA), Disease Activity index for PSoriatic Arthritis (DAPSA) remission and patient-reported outcomes.

From a total of 708 PsA patients the diagnostic delays were categorized as:

  • Short delays (19%)
  • Intermediate delays (33%) 
  • Long delays (47%) 
  • Delays were moreso physician delays (4.5 months) than Patient delay (1.0 month)

The chance of MDA (OR 2.55) and DAPSA remission (OR 2.35) was best with a short delay (compared to long delay). Similarly, PRO's were numerically better (NS) between the short and long delay groups. 

Long delay patients were more likely to be female, with enthesitis, chronic back pain or normal C-reactive protein. 

An important window of opportunity exists in the referral and diagnosis of PsA patients. 


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