Diagnostic Delay of Psoriatic Arthritis of More Than Six Months Contributes to Poor Patient-Reported Outcome Measures in Depression, Social Ability, and Disease Impact: A Cross-sectional Study.

Objective: We sought to correlate the time lag between psoriatic arthritis (PsA) symptom onset and diagnosis to the likelihood and severity of depression, social impairment, and disease impact on quality of life.

Methods: This cross-sectional study conducted by the National Psoriasis Foundation (NPF) surveyed individuals with PsA using patient-reported outcome measures.

Results: The analysis cohort comprised 2,196 patients with PsA. Likelihood of depression progressively increased when time between PsA symptom onset and diagnosis was beyond six months (28.6% <6 months; 29.6% 7-12 months; 38.1% 13-24 months; 35.4% >2 years; p<0.01). Individuals with more than six months delay reported increasingly higher rates of experiencing moderate limitation in social participation (22.9% <6 months; 29.2% 7-12 months; 34.0% 13-24 months; 35.3% >2 years; p<0.001). Unacceptable PsA symptom rates (PsAID score >4) increased with time between PsA symptom onset and diagnosis (74.7% <6 months; 76.4% 7-12 months; 80.8% 13-24 months; 81.6% >2 years; p<0.05). These relationships persisted in body mass index (BMI) and age adjusted models.

Limitations: The study only includes participants who were active members of the NPF, and all data was self-reported.

Conclusion: Our results demonstrate that delays between PsA symptom onset and diagnosis that are greater than six months lead to increased likelihoods of depression, social disengagement, and impaired quality of life, and that longer delays lead to increasingly worse outcomes in these domains.