ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 694

Diagnostic Delay Leads to Worse Response to Treatment

Marijn Vis1, Kim Wervers2, Ilja Tchetverikov3, Mark R. Kok4, Lindy-Anne Korswagen5, Andreas H. Gerards6, Hans van Groenendaal7, Jozien Veris8, Wiebo L. van der Graaff9, Cathelijne W. Y. Appels10, Johanna M.W. Hazes11 and Jolanda J. Luime1, 1Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands, 2Erasmus Medical Centre, Rotterdam, Netherlands, 3Albert Schweitzer Hospital, Dordrecht, Netherlands, 4Rheumatology, Maasstad Hospital, Rotterdam, Netherlands, 5Sint Franciscus Gasthuis, Rotterdam, Netherlands, 6Rheumatology, Vlietland Hospital, Schiedam, Netherlands, 7Rheumatology, ReumaZorg ZuidWest nederland, Roosendaal, Netherlands, 8Rheumatology, Reumazorg Zuid West Nederland, Goes, Netherlands, 9Rheumatology, Rivas hospital, Gorinchem, Netherlands, 10Rheumatology, Amphia Hospital, Breda, Netherlands, 11Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, Netherlands

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: ,

Session Information

Date: Sunday, November 13, 2016

Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster I: Axial and Peripheral Spondyloarthritis – Clinical Aspects, Imaging and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Is there a clinical patient profile for PsA Patients with a diagnostic delay?

Background/Purpose: Psoriatic arthritis (PsA) is a progressive inflammatory musculoskeletal disease. Several recent studies have shown that a delay in diagnosis leads to a worse outcome. Haroon et al showed that a delay of more than 6 months from symptom onset contributes to the development of erosions and worse long-term physical function. 1 In this study we will investigate the patient profile of PsA patients with a diagnostic delay.

Methods: Data of incident PsA patients was used from the Dutch South-West Psoriatic Arthritis Registry (DEPAR) study between August 2013 and March 2016. The DEPAR includes newly diagnosed PsA patients from 8 hospitals in the South-West of the Netherlands. Patients are followed every 3 months during the first year. PsA core measurements were collected: Swollen and Tender join count (66/68), enthesitis (LEI and MASES), dactylitis (LDI) and psoriasis (PASI). In addition measures of quality of life (SF-36) and health (HAQ) are collected The groups with symptom duration longer than 6 months and shorter than 6 months were compared using parametric and non-parametric tests where appropriate.

Results: In total, 316 patients had a baseline assessment. Average age was 50.4 years (SD 13.7) and 50% were male. The median duration of complaints to diagnosis was 11.6 months (range 0-586). The median time from first visit to the general practitioner to diagnosis was 4.4 months (range 0-374). Patients with symptom duration shorter than 6 months were slightly older (52.7 (SD 14.6) vs. 49.1 (SD13.3) p<0.05) were more frequently male (60% vs 40%, p <0.05) and had less enthesitis (39% vs 52%, p<0.05). There was no difference in the other disease features nor quality of life or health. (table 1) Patient with a shorter symptom duration than 6 months seemed to have a better response to treatment as shown by the lower PASDAS and CPDAI scores at 3 and 6 months.

Conclusion: PsA patients with diagnostic delay for more than 6 months were more likely to be female and enthesitis more frequently and seemed to have a higher disease during follow-up as measured by CPDAI and PASDAS at 3 and 6 months. Reference 1. Haroon M. et al, diagnostic delay of more than 6 months contributes to a poor radiographic and functional outcome. Ann Rheum Dis 2015;74:1045-1050

Baseline   3 months   6 months
N 109 207   93 176   83 148
  short long   short long   short long
Female  (%) 40% 60%*            
Age mean (SD) 52.7 (14.6) 49.1 (13.3)*            
                 
swollen joints median (range) 2 (0-21) 2 (0-21)   1 (0-11) 1 (0-16)   0 (0-13) 0 (0-14)
tender joints median (range) 3 (0-23) 3 (0-58)   2 (0-30) 1 (0-21)   0 (0-13) 1 (0-30)*
Dactylitis  (%) 14% 11%   9% 4%   7% 4%
Enthesitis (%) 39% 52% *   31% 43%   21% 43% **
PASI median (range) 2.4 (0-21) 1.8 (0-20)   1.2 (0-14) 1.0 (0-13)   1.65 (0-19) 2.0 (0-20)
                 
SF-36 PCS mean (SD) 40.2 (8.4) 39.7 (8.5)   43.0 (8.6) 41.29 (8.9)   42.6 (9.2) 42.4 (9.2)
SF-36 MCS mean (SD) 48.2 (10.8) 47.1 (10.2)   48.1 (11.3) 45.6 (11.0)   49.4 (10.4) 47.23 (10.9)*
                 
HAQ median (range) 5.0 (0-18) 6 (0-18)   4.0 (0-18) 5.0 (0-24)   3.5 (0-19) 5 (0-21)
                 
PASDAS mean (SD) 4.01 (1.2) 4.1 (1.1)   3.2 (1.1) 3.45 (1.1)*   2.97 (1.1) 3.2 (1.3)
CPDAI mean (SD) 5.7 (2.2) 6.1 (2.5)   4.4 (2.0) 5.0 (2.4)   3.73 (2.1) 4.8 ( 2.4)*

* p <0.05 and **p < 0.001 compared to short disease duration Enthesitis: LEI and MASES, Dactylitis: LDI

Disclosure: M. Vis, None; K. Wervers, None; I. Tchetverikov, None; M. R. Kok, None; L. A. Korswagen, None; A. H. Gerards, None; H. van Groenendaal, None; J. Veris, None; W. L. van der Graaff, None; C. W. Y. Appels, None; J. M. W. Hazes, None; J. J. Luime, None.

To cite this abstract in AMA style:

Vis M, Wervers K, Tchetverikov I, Kok MR, Korswagen LA, Gerards AH, van Groenendaal H, Veris J, van der Graaff WL, Appels CWY, Hazes JMW, Luime JJ. Diagnostic Delay Leads to Worse Response to Treatment [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/diagnostic-delay-leads-to-worse-response-to-treatment/. Accessed .

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