https://doi.org/10.4081/reumatismo.2024.1607
Evaluation of diagnostic and therapeutic delay in patients with rheumatoid arthritis and psoriatic arthritis
Submitted: 5 July 2023
Accepted: 4 December 2023
Published: 22 March 2024
Accepted: 4 December 2023
Abstract Views: 676
PDF: 333
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Objective. A monocentric cross-sectional study recruiting rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients residing in the Lazio region, Italy, to assess factors related to diagnostic delay and treatment accessibility.
Methods. Clinical/serological data, including the time between symptom onset, diagnosis, and the beginning of treatment, were collected. Residence, referral to a rheumatologic center, physician who made the diagnosis, and previous misdiagnosis were also evaluated.
Results. A higher diagnostic delay (p=0.003), and time between symptom onset and the start of I-line therapy (p=0.006) were observed in PsA compared to RA. A delayed start of II-line therapy was observed in RA compared to PsA (p=0.0007). Higher diagnostic delay (p=0.02), and time between symptom onset and the start of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) (p=0.02) were observed among residents of small-medium cities for both groups. Patients who have been diagnosed by another physician rather than a rheumatologist had a longer diagnostic delay (p=0.034) and a delayed start of I-line therapy (p=0.019). Patients who received a different previous diagnosis experienced greater diagnostic delay (p=0.03 and p=0.003) and time of start of csDMARDs (p=0.05 and p=0.01) compared with those receiving RA or PsA as the first diagnosis. PsA had a delay in starting targeted synthetic disease-modifying anti-rheumatic drugs (p=0.0004) compared to RA. Seronegative RA had delayed diagnosis (p=0.02) and beginning of therapies (p=0.03; p=0.04) compared to seropositive ones.
Conclusions. According to our results, greater diagnostic delay was found in PsA compared to RA, in patients living in small-medium cities, in those who did not receive the diagnosis from a rheumatologist, in those who were previously misdiagnosed, and in seronegative RA.
Jang S, Kwon EJ, Lee JJ. Rheumatoid arthritis: pathogenic roles of diverse immune cells. Int J Mol Sci 2022; 23: 905.
DOI: https://doi.org/10.3390/ijms23020905
Hochberg MC. Changes in the incidence and prevalence of rheumatoid arthritis in England and Wales, 1970-1982. Semin Arthritis Rheum 1990; 19: 294-302.
DOI: https://doi.org/10.1016/0049-0172(90)90052-H
Ogdie A, Weiss P. The epidemiology of psoriatic arthritis. Rheum Dis Clin North Am 2015; 41: 545-68.
DOI: https://doi.org/10.1016/j.rdc.2015.07.001
Gottlieb AB, Dann F. Comorbidities in patients with psoriasis. Am J Med 2009; 122: 1150.e1-9.
DOI: https://doi.org/10.1016/j.amjmed.2009.06.021
Kavanaugh A. Psoriatic arthritis: treat-to-target. Clin Exp Rheumatol 2012; 30: S123-5.
Chimenti MS, Triggianese P, Conigliaro P, Tonelli M, Gigliucci G, Novelli L, et al. A 2-year observational study on treatment targets in psoriatic arthritis patients treated with TNF inhibitors. Clin Rheumatol 2017; 36: 2253-60.
DOI: https://doi.org/10.1007/s10067-017-3769-4
Sunzini F, D'Antonio A, Fatica M, Triggianese P, Conigliaro P, Greco E, et al. What's new and what's next for biological and targeted synthetic treatments in psoriatic arthritis?. Expert Opin Biol Ther 2022; 22: 1545-59.
DOI: https://doi.org/10.1080/14712598.2022.2152321
Bakker MF, Jacobs JW, Verstappen SM, Bijlsma JW. Tight control in the treatment of rheumatoid arthritis: efficacy and feasibility. Ann Rheum Dis 2007; 66: iii56-60. Erratum in: Ann Rheum Dis 2008; 67: 140.
DOI: https://doi.org/10.1136/ard.2007.078360
Lard LR, Visser H, Speyer I, vander Horst-Bruinsma IE, Zwinderman AH, Breedveld FC, et al. Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. Am J Med 2001; 111: 446-51.
DOI: https://doi.org/10.1016/S0002-9343(01)00872-5
Möttönen T, Hannonen P, Korpela M, Nissilä M, Kautiainen H, Ilonen J, et al. Delay to institution of therapy and induction of remission using single-drug or combination-disease-modifying antirheumatic drug therapy in early rheumatoid arthritis. Arthritis Rheum 2002; 46: 894-8.
DOI: https://doi.org/10.1002/art.10135
Conigliaro P, D'Antonio A, D'Erme L, Lavinia Fonti G, Triggianese P, Bergamini A, et al. Failure and multiple failure for disease modifying antirheumatic drugs in rheumatoid arthritis: Real-life evidence from a tertiary referral center in Italy. PLoS One 2023; 18: e0281213.
DOI: https://doi.org/10.1371/journal.pone.0281213
Kane D, Stafford L, Bresnihan B, FitzGerald O. A prospective, clinical and radiological study of early psoriatic arthritis: an early synovitis clinic experience. Rheumatology (Oxford) 2003; 42: 1460-8.
DOI: https://doi.org/10.1093/rheumatology/keg384
Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis 2015; 74: 1045-50.
DOI: https://doi.org/10.1136/annrheumdis-2013-204858
Bécède M, Alasti F, Gessl I, Haupt L, Kerschbaumer A, Landesmann U, et al. Risk profiling for a refractory course of rheumatoid arthritis. Semin Arthritis Rheum 2019; 49: 211-7.
DOI: https://doi.org/10.1016/j.semarthrit.2019.02.004
NICE. Rheumatoid arthritis in adults: management NICE guidelines; 2018. Available from: https://www.nice.org.uk/guidance/ng100/chapter/Recommendations. Accessed on: 22/12/2020.
Karmacharya P, Wright K, Achenbach SJ, Bekele D, Crowson CS, Ogdie A, et al. Diagnostic delay in psoriatic arthritis: a population-based study. J Rheumatol 2021; 48: 1410-6.
DOI: https://doi.org/10.3899/jrheum.201199
Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005; 64: ii14-7.
DOI: https://doi.org/10.1136/ard.2004.032482
Meer E, Thrastardottir T, Wang X, Dubreuil M, Chen Y, Gelfand JM, et al. Risk factors for diagnosis of psoriatic arthritis, psoriasis, rheumatoid arthritis, and ankylosing spondylitis: a set of parallel case-control studies. J Rheumatol 2022; 49: 53-9.
DOI: https://doi.org/10.3899/jrheum.210006
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, Bingham CO 3rd, et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69:1580-8.
DOI: https://doi.org/10.1136/ard.2010.138461
Taylor W, Gladman D, Helliwell P, Marchesoni A, Mease P, Mielants H, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006; 54: 2665-73.
DOI: https://doi.org/10.1002/art.21972
Sørensen J, Hetland ML; all departments of rheumatology in Denmark. Diagnostic delay in patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis: results from the Danish nationwide DANBIO registry. Ann Rheum Dis 2015; 74: e12.
DOI: https://doi.org/10.1136/annrheumdis-2013-204867
Tiwari V, Brent LH. Psoriatic Arthritis. Treasure Island, FL, USA: StatPearls Publishing, 2022.
Coates LC, Helliwell PS. Psoriatic arthritis: state of the art review. Clin Med 2017; 17: 65-70.
DOI: https://doi.org/10.7861/clinmedicine.17-1-65
Naeem F, Khan SEA, Saeed MA, Farman S. Diagnostic and therapeutic delay in rheumatoid arthritis patients: impact on disease outcome. Pak J Med Sci 2021; 37: 1001-7.
DOI: https://doi.org/10.12669/pjms.37.4.3471
Cassone G, Manfredi A, Vacchi C, Luppi F, Coppi F, Salvarani C, et al. Treatment of rheumatoid arthritis-associated interstitial lung disease: lights and shadows. J Clin Med 2020; 9: 1082.
DOI: https://doi.org/10.3390/jcm9041082
Pratt AG, Lendrem D, Hargreaves B, Aslam O, Galloway JB, Isaacs JD. Components of treatment delay in rheumatoid arthritis differ according to autoantibody status: validation of a single-centre observation using national audit data. Rheumatology (Oxford) 2016; 55: 1843-8.
DOI: https://doi.org/10.1093/rheumatology/kew261
Iyengar KP, Vaish A, Nune A. Anti-cyclic citrullinated peptide antibody (ACPA) and rheumatoid arthritis: clinical relevance. J Clin Orthop Trauma 2021; 24: 101729.
DOI: https://doi.org/10.1016/j.jcot.2021.101729
Coates LC, Soriano ER, Corp N, Bertheussen H, Callis Duffin K, et al. Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA): updated treatment recommendations for psoriatic arthritis 2021. Nat Rev Rheumatol 2022; 18: 465-79. Erratum in: Nat Rev Rheumatol 2022; 18: 734.
DOI: https://doi.org/10.1038/s41584-022-00861-w
Barnabe C, Xiong J, Pope JE, Boire G, Hitchon C, Haraoui B, et al. Factors associated with time to diagnosis in early rheumatoid arthritis. Rheumatol Int 2014; 34: 85-92.
DOI: https://doi.org/10.1007/s00296-013-2846-5
Passia E, Vis M, Coates LC, Soni A, Tchetverikov I, Gerards AH, et al. Sex-specific differences and how to handle them in early psoriatic arthritis. Arthritis Res Ther 2022; 24: 22.
DOI: https://doi.org/10.1186/s13075-021-02680-y
Lubrano E, Scriffignano S, Fatica M, Triggianese P, Conigliaro P, Perrotta FM, et al. Psoriatic arthritis in males and females: differences and similarities. Rheumatol Ther 2023; 10: 589-99.
DOI: https://doi.org/10.1007/s40744-023-00535-3
Jovaní V, Blasco-Blasco M, Ruiz-Cantero MT, Pascual E. Understanding how the diagnostic delay of spondyloarthritis differs between women and men: a systematic review and metaanalysis. J Rheumatol 2017; 44: 174-83.
DOI: https://doi.org/10.3899/jrheum.160825
Neill J. Transcendence and transformation in the life patterns of women living with rheumatoid arthritis. ANS Adv Nurs Sci 2002; 24: 27-47.
DOI: https://doi.org/10.1097/00012272-200206000-00008
Villeneuve E, Nam JL, Bell MJ, Deighton CM, Felson DT, Hazes JM, McInnes IB, et al. A systematic literature review of strategies promoting early referral and reducing delays in the diagnosis and management of inflammatory arthritis. Ann Rheum Dis 2013; 72: 13-22.
DOI: https://doi.org/10.1136/annrheumdis-2011-201063
Gladman DD, Shuckett R, Russell ML, Thorne JC, Schachter RK. Psoriatic arthritis (PSA)--an analysis of 220 patients. Q J Med 1987; 62: 127-41.
Deane KD, Striebich CC, Goldstein BL, Derber LA, Parish MC, Feser ML, et al. Identification of undiagnosed inflammatory arthritis in a community health fair screen. Arthritis Rheum 2009; 61: 1642-9.
DOI: https://doi.org/10.1002/art.24834
Simons G, Ismail N, Sandhu K, Mallen CD, Stack RJ, Pontefract S, et al. The potential role of community pharmacy staff in reducing patient delay in consulting with symptoms of rheumatoid arthritis: a qualitative study. BMC Rheumatol 2022; 6: 50.
DOI: https://doi.org/10.1186/s41927-022-00280-0
Haroon M, Kirby B, FitzGerald O. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis 2013; 72: 736-40.
DOI: https://doi.org/10.1136/annrheumdis-2012-201706
Conigliaro P, Chimenti MS, Ascolani M, Triggianese P, Novelli L, Onali S, et al. Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients. Autoimmun Rev 2016; 15: 184-90.
DOI: https://doi.org/10.1016/j.autrev.2015.11.002
Eder L, Law T, Chandran V, Shanmugarajah S, Shen H, Rosen CF, et al. Association between environmental factors and onset of psoriatic arthritis in patients with psoriasis. Arthritis Care Res (Hoboken) 2011; 63: 1091-7.
DOI: https://doi.org/10.1002/acr.20496
Helliwell P, Coates L, Chandran V, Gladman D, de Wit M, FitzGerald O, et al. Qualifying unmet needs and improving standards of care in psoriatic arthritis. Arthritis Care Res (Hoboken) 2014; 66: 1759-66.
DOI: https://doi.org/10.1002/acr.22404
How to Cite
Iacovantuono, M., Ferrigno, S., Conigliaro, P., Triggianese, P., D’Antonio, A., Spinelli, F., … Chimenti, M. (2024). Evaluation of diagnostic and therapeutic delay in patients with rheumatoid arthritis and psoriatic arthritis. Reumatismo, 76(1). https://doi.org/10.4081/reumatismo.2024.1607
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