PsA Patients Have More Medical Visits in Five Years Leading Up to Diagnosis

A new study evaluated healthcare utilization among psoriatic arthritis (PsA) patients in the years leading up to their diagnosis. The researchers concluded here that PsA patients are significantly more likely to have medical visits than other patients during the time period leading up to their diagnosis, going back as far as five years.

“PsA is a heterogeneous disease that can present in various clinical manifestations, such as synovitis, enthesitis, dactylitis and spondylitis,” the study authors explained. “Some of these features can present with only minimal findings on physical examination, and the differentiation from other conditions, such as osteoarthritis, can be challenging. Furthermore, unlike RA and lupus, PsA has no reliable diagnostic biomarkers. These factors, along with the lack of awareness of PsA among patients and primary care physicians, and limited access to specialty care contribute to delays in the diagnosis of PsA.”

Better pre-diagnosis may be beneficial to disease treatment and outcomes, the researchers noted, so they explored the burden of musculoskeletal symptoms among patients who were eventually diagnosed with PsA.

The study was a population-based, matched cohort study that collected data from electronic medical records and administrative data in Ontario, Canada. PsA patients were age- and sex-matched to control patients from the same family physicians. Control patients were eligible for inclusion if they did not have a billing code indicating a diagnosis of spondyloarthritis, ankylosing spondylitis, or rheumatoid arthritis. Outcomes included healthcare utilization and costs pertaining to nonspecific musculoskeletal issues over the five-year period leading up to the index date.

PsA Patients More Likely to Utilize Healthcare Services Even Before Diagnosis

Final analysis included 462 PsA patients and 2,310 controls (mean [SD] age, 54.2 [13.8] years; 55.6% were female). PsA patients were significantly more likely to visit a primary care physician for nonspecific musculoskeletal issues in the year leading up to the index date (odds ratio [OR]=2.14; 95% confidence interval [CI], 1.73–2.64); this trend was also observed in the five years leading up to the index date (OR=1.76; 95% CI, 1.43–2.18). PsA patients were also more likely than the controls to require musculoskeletal-related specialty care, diagnostic imaging and procedures prior to the index date. PsA patients were more likely to be assessed by nonrheumatologist musculoskeletal specialists (OR range, 1.59–2.03), visit an emergency department for musculoskeletal-related issues (OR range, 1.33–2.69), and have joint imaging (OR range, 3.20–6.26) and joint injections (OR range, 4.63–9.26).

Over the five years before index date, PsA patients were at least four times more likely than the controls to visit a rheumatologist. The most common diagnosis codes rheumatologists provided were for “other disease of the musculoskeletal systems,” “psoriasis,” “osteoarthritis,” and “cramps, leg pain, muscle pain, joint pain, joint swelling.”

The study appeared in Arthritis Care & Research.

The study authors concluded of the findings, “his pattern reveals some of the underlying causes of diagnosis delays of PsA and highlights the need for diagnostic strategies and novel reliable biomarkers to aid in early diagnosis of PsA.”