Background Despite increasing awareness of psoriatic arthritis (PsA) among physicians, the prevalence of undiagnosed PsA remains high (1). Increased understanding of the real-world pattern of PsA disease diagnosis and management could reduce under-diagnosis and facilitate earlier initiation of appropriate treatment.
Objectives The aim of this retrospective cohort study was to describe patient characteristics, patterns of referral to a rheumatologist, drug therapy use and outpatient visits in PsA.
Methods The electronic medical records (EMR) for patients diagnosed with PsA in secondary care between 2008 and 2013 in Uppsala County Council in Sweden (n=350,000) were extracted. Anonymous data on age, gender, drugs administered by injection or infusion, diagnoses and referrals were retrieved from the EMR. Data was merged with information on procedures and prescribed drugs by the Swedish National Board of Health and Welfare. Treatment was described for patients who had at least 1.5 years of records available after PsA diagnosis; separately for patients cared for by rheumatologists, dermatologists, and orthopedists in secondary care (“Referred” group) and the remaining patients considered being treated in primary care setting (“Referred back” group).
Results There were 415 incident cases of PsA in the secondary care EMR. The majority of these patients (N=383, 92%) were diagnosed with PsA by a rheumatologist and formed the study cohort. Average age was 49 years; 158 (41%) were males. 175 (46%) had a prior psoriasis diagnosis made in secondary care; 81% by a dermatologist. The average duration between psoriasis diagnosis and PsA diagnosis was 3.8 years; during which time the average patient made 2.7 dermatologist and 1.0 orthopedist visits in the secondary care setting. 282 patients had at least 1.5 years of follow-up after PsA diagnosis; the majority were treated by rheumatologists, dermatologists and orthopedists (Referred group, N=228; 75%). Remaining patients (Referred-back group, N=54; 25%) were treated in primary care. During the first year after diagnosis “Referred” patients had a higher average number of secondary care outpatient visits (3.9 per year, 77% rheumatologist) than “Referred back” patients (1.1 per year). The medical treatment given during this period is described for the two groups (Table 1).
Conclusions Most PsA patients were diagnosed by a rheumatologist and post-diagnosis management of PsA is typically done in secondary care. Most patients who received a psoriasis diagnosis in secondary care prior to PsA received it from a dermatologist, on average 3.8 years prior to PsA diagnosis. Patients who were managed in secondary care were more likely to receive drug therapy possibly indicating greater disease severity.
Haroon M, et al. High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires. Ann Rheum Dis. 2013;72(5):736-40.
Disclosure of Interest J. Rockberg Consultant for: AbbVie, Employee of: Pygargus AB/IMS Health, M. Mittal Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, A. Joshi Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, Y. Bao Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, J. Anderson Shareholder of: AbbVie Inc, Employee of: AbbVie Inc, R. Linder Consultant for: AbbVie Inc, Employee of: Pygargus AB/IMS Health, J. Stålhammar Grant/research support from: AbbVie Inc, U. Lindqvist Grant/research support from: AbbVie Inc