• Psoriasis and arthritis are commonly diagnosed in people before they receive a psoriatic arthritis (PsA) diagnosis, according to a recent study.
• Rheumatologists are more likely to diagnose cases of PsA, compared to general practitioners and dermatologists.
• Recognizing early signs of PsA may help health care providers more quickly and accurately diagnose the condition, preventing joint damage and erosion.

Certain conditions, including psoriasis and rheumatoid arthritis, are often present in people before they’re diagnosed with psoriatic arthritis (PsA), according to a recent study. The findings may help health care providers diagnose PsA more accurately and in a more timely manner, which can help prevent the long-term joint damage that comes with the condition.

“Timely referral of a patient with potential PsA for rheumatology evaluation is critical to improving outcomes for patients with PsA, and this has been recognized for some time,” according to the study, titled “Longitudinal Analysis of the Patient Pathways to Diagnosis of Psoriatic Arthritis.” “The ability to identify PsA symptoms early in the disease course, in addition to recognizing specific trends and patterns in a patient’s pursuit for diagnosis, may permit prompt referral to appropriate specialists, leading to an earlier diagnosis of PsA.”

Psoriatic Arthritis Diagnosis Is Often Delayed

PsA is a complicated, chronic, inflammatory disease that affects both the skin and joints, and it can present with a wide variety of symptoms. These can develop slowly over time or more quickly with greater severity. If PsA goes undiagnosed, these symptoms can lead to joint damage and erosion over time.

Unfortunately, many people living with psoriatic arthritis do not receive a timely diagnosis. A 2020 cross-sectional study from the U.S. found that, among 203 participants with self-reported PsA, one-third had received their diagnosis within six months to four years of seeking medical attention. Another third waited more than five years. Participants in this study had met with multiple health care providers who were unable to provide a PsA diagnosis.

The authors of the new study sought to help improve the diagnosis time of those with PsA and understand their path to diagnosis.

Psoriasis, Joint Pain Are Common Before PsA Diagnosis

The researchers collected information from three claims databases that included inpatient and outpatient information spanning from January 2006 to April 2019. In total, 13,661 participants were included in the study.

Compared to controls (those without PsA), participants with PsA were diagnosed more often with skin conditions and arthritis. This includes:

• Rheumatoid arthritis — 18.1 percent versus 2.3 percent
• Osteoarthritis — 47.8 percent versus 21.7 percent
• Psoriasis — 61.3 percent versus 1.9 percent
• Inflammatory polyarthropathy (IA) — 17.6 percent versus 1 percent

In the six years leading up to their PsA diagnosis, many participants had reported joint swelling and pain, skin issues, osteoarthritis, psoriasis, or tendonitis. Interestingly, in the six months before a PsA diagnosis, diagnoses of psoriasis, osteoarthritis, and IA also increased.

Rheumatologists Diagnose Most PsA Cases

The study also found that participants sought out a variety of health care professionals for their diagnosis, including general practitioners, dermatologists, and rheumatologists. More participants saw their health care providers in the six months leading up to their diagnosis than in the years prior.

The type of provider also influenced the diagnosis that a participant received. For example, rheumatologists were less likely to address psoriasis, while dermatologists were less likely to address arthritis and other joint issues. Overall, rheumatologists diagnosed 39.8 percent of PsA cases, while general practitioners and dermatologists diagnosed 22.3 percent and 7.3 percent of cases, respectively.