Psoriatic arthritis

Delays in Diagnosis and Misdiagnoses Appear Common in Psoriatic Arthritis

Persons with psoriatic arthritis (PsA) experience substantial delays and misdiagnoses before receiving a PsA diagnosis, according to findings of a new study.

Real-world data on the diagnostic experiences of patients with PsA—including medical care sought and potential barriers to diagnosis—are limited.


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To address this, Alexis Ogdie, MD, MSCE, from the University of Pennsylvania, and colleagues conducted a mixed-method, 2-phase study. Phase 1 comprised concept elicitation and cognitive interviews with clinical experts and adults with a PsA diagnosis to develop a cross-sectional, web-based survey. Adults with a self-reported PsA diagnosis were recruited through a patient support community, an online patient research registry, and social media outreach. Phase 2 included data collected from the online survey on sociodemographics, clinical symptoms, disease burden, and diagnosis history of survey respondents with PsA.

Self-reported experiences of PsA diagnosis among 203 respondents were examined by the researchers.

Results showed that only one-third of respondents sought medical treatment within 1 year of the onset of symptoms. The time between seeking medical attention and receiving a diagnosis of PsA was less than 6 months for 69 respondents, between 6 months and 4 years for 68 respondents, and 5 years or longer for 66 respondents.

Joint pain (70.0%) and stiffness (53.7%) were the common symptoms that led the respondents to seek initial medical attention.

Differences in disease symptoms were observed among respondents with shorter vs longer time to receiving a PsA diagnosis—joint pain, swollen joints, and sausage-like fingers or toes were more common among those with a shorter time to diagnosis, whereas stiffness, fatigue, enthesitis, and back pain were more common among those with a longer time to diagnosis.

The authors noted that differences in presenting symptoms may have played a role in the time to diagnosis.

Respondents with shorter times to diagnosis had lower frequencies of misdiagnosis and were more likely to seek care from dermatologists and rheumatologists.

Common misdiagnoses among the respondents included psychosomatic issues (26.6%) and osteoarthritis (21.7%).

“Our study showed that many people living with PsA faced a winding path to arrive at a diagnosis, migrating through various types of healthcare providers prior to the diagnosis,” the authors concluded. “Increased recognition of heterogeneous symptoms associated with PsA, as well as understanding existing diagnostic barriers, may lead to prompt diagnosis and initiation of appropriate treatment that may improve outcomes.”

—Melinda Stevens


Ogdie A, Benjamin Nowell W, Applegate E. et al. Patient perspectives on the pathway to psoriatic arthritis diagnosis: results from a web-based survey of patients in the United States [published online January 10, 2020]. BMC Rheumatol. doi:10.1186/s41927-019-0102-7.