Don't delay proper psoriatic arthritis diagnoses more than 6 months

[Fred]

None of us like visiting our doctor but getting early diagnoses can pay off in the long run, this study looked at psoriasis patients getting a diagnoses of psoriatic arthritis (PsA) it suggests it may not be a good idea to put off a proper diagnoses longer than 6 months.

Quote:

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Objectives:
To investigate the demographic and clinical characteristics contributing to the delay from symptom onset to the first visit to a rheumatologist; to compare clinical, radiographic and patient-reported outcome measures of those who saw a rheumatologist early in their disease course with those who were diagnosed later.

Methods:
All psoriatic arthritis (PsA) patients, fulfilling CASPAR criteria, with an average disease duration of >10 years were invited for detailed clinical evaluation. The total lag time from symptom onset to their first rheumatological encounter was studied. The data were extracted from the referral letters and medical records. Patients were classified as early consulters or late consulters depending on whether they were seen by a rheumatologist within or beyond 6 months of symptom onset.

Results:
283 PsA patients were studied. Median lag time from the disease onset to the first rheumatological assessment of the cohort was 1.00 years (IQR 0.5–2). 30% (n=86), 53% (n=149) and 71% (n=202) of the cohort were seen by a rheumatologist within 6 months, 1 and 2 years of symptom onset, respectively. PsA patients with low education status (OR 2.09, p=0.02) and Body Mass Index (OR 0.92, p=0.01) were significantly more likely to have a diagnostic delay of >2 years. On multiple stepwise regression analysis, the model predicted significant association of late consulters with the development of peripheral joint erosions (OR 4.25, p=0.001) and worse Health Assessment Questionnaire scores (OR 2.2, p=0.004).

Conclusions:
Even a 6-month delay from symptom onset to the first visit with a rheumatologist contributes to the development of peripheral joint erosions and worse long-term physical function.

Source: bmj.com

So if you think you have the symptoms of Psoriatic Arthritis don't put it off go and get it checked out.

[jiml]

Well it's good to read a survey that tells us we have known for ages let's hope GP's and specialists read this and make sure patients get fast treatment after diagnosis
We have seen on here members waiting months while insurance companies fight not to supply what was prescribed.... Perhaps this should be sent to medical insurers so they can see that a delay to save a few dollars will inevitably cost more when joints deteriate

[Caroline]

Yes, indeed Jim.
But the reumatologists who can make the diagnose, still very often don't know what to do afterwards.
But also it is interesting to warn the patients that run into the problem. They don't know what they are dealing with and it can take a long time to realize what is going on with you.
E.g. It took me too long, so now I cannot do my favorite running anymore and had to change to bicycling and spinning.

[jiml]

Yes, indeed Jim.
But the reumatologists who can make the diagnose, still very often don't know what to do afterwards.
But also it is interesting to warn the patients that run into the problem. They don't know what they are dealing with and it can take a long time to realize what is going on with you.
E.g. It took me too long, so now I cannot do my favorite running anymore and had to change to bicycling and spinning.

That is very true Caroline many rheumatologists haven't caught up yet with the modern medicines and those that have have one hand tied behind their backs and they have to ration the drugs by giving drugs like methotrexate and sulfasalazine for patients to fail on although some do get relief in these drugs it's not known if they inhibit joint damage
Whereas they know bio drugs and DMF drugs do work but they are too expensive
I was watching a great lecture by a rheumatologist earlier and he himself admitted that he gave patients inferior drugs like methotrexate although he knows the best treatment is too expensive to prescribe...... It's a shame but I fear it's a common tale in all branches of medicine the drugs are there but governments and insurers just can't afford them for every body

[mataribot]

Traditional DMARDs are NOT proper treatment for PsA. Denying treatment now will cost them more later.

[Caroline]

Traditional DMARDs are NOT proper treatment for PsA. Denying treatment now will cost them more later.

I totally agree with you Mataribot.
The doctors but also the insurance companies are so 'not knowledgeable' and shortsighted.
Problem is that everything in their eyes should be scientifically proven and that take an awful lot of time. But they forget to look in the history of their patients. There lies a vast amount of ready to grab information what can easily lead to strong conclusions.

[mataribot]

Not all insurance companies lose money on biologics. It's not hard to get a dermatologist to approve a biologic - they are less bullied by insurance companies. Most Rheumatologist choose not to fight the insurance companies because it effects their bottom line.