Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set

Rachel Charlton; Emer Gates; Laura  Coates; James Galloway; Neil McHugh; Anita McGrogan; Simon Hackett; Melanie Brooke; Charlotte Cavill; W Tillett

doi:10.1016/j.ard.2025.02.020

Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set

Rachel Charlton, Emer Gates, Laura Coates, James Galloway, Neil McHugh, Anita McGrogan, Simon Hackett, Melanie Brooke, Charlotte Cavill, W Tillett

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives: This study aimed to compare time to diagnosis among patients with psoriatic arthritis (PsA) with that of patients with rheumatoid arthritis (RA) and compare initial treatment and outcomes. Methods: Patients with PsA were identified from the National Early Inflammatory Arthritis Audit between May 2018 and October 31, 2019, and matched to patients with RA (1:1) on age and sex. Patient characteristics and time to diagnosis were compared between PsA and RA groups. Further comparisons were made, restricted to matched pairs of patients with polyarticular PsA, including disease activity, disease impact, and treatment initiation. Results: In total, 2120 patients with PsA were matched to patients with RA, of which 1250 had polyarticular disease. Symptom duration before referral was longer in patients with PsA than that in patients with RA. Patients with PsA had a longer time from general practitioner (GP) presentation to diagnosis (mean, 112 v 89 days; hazard ratio [HR], 0.87; 95% CI, 0.79-0.96; P = .007), including a delay in diagnosis once referrals were received in secondary care (HR, 0.86; 95% CI, 0.80-0.95; P = .002). In patients with polyarticular disease, less disease-modifying antirheumatic drugs (DMARDs) were prescribed at baseline to patients with PsA compared with those to patients with RA (54.0% and 69.0%, respectively; P < .001). Patients with RA had a higher Disease Activity Score in 28 joints at baseline, but by 3 months, the average score was 0.27 (95% CI, 0.13-0.4) higher in patients with PsA. Conclusions: Compared with patients with RA, patients with PsA have a longer duration of symptoms before referral and a longer interval between presentation to the GP and receiving a diagnosis. Most people agreed a treat-to-target strategy but fewer DMARDs were commenced for patients with PsA than those for patients with RA and a lower improvement in disease activity was achieved at 3 months, suggesting undertreatment.

Original language	English
Pages (from-to)	970-978
Number of pages	9
Journal	Annals of the Rheumatic Diseases
Volume	84
Issue number	6
Early online date	29 Mar 2025
DOIs	https://doi.org/10.1016/j.ard.2025.02.020
Publication status	Published - Jun 2025

Data Availability Statement

Data are not available for this project as part of the data sharing agreement between the National Early Arthritis Audit and the Royal United Hospitals National Health Service foundation trust the data has been destroyed on completion of the analysis.

Funding

We would like to thank the National Early Inflammatory Arthritis Audit team for their support in conducting this project and the participants in the audit without whom this project would not have been possible. Part of this work was presented at the ACR Convergence 2022. Charlton R, Coates L, Galloway J, McHugh N, McGrogan A, Hackett S, et al. Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a nested matched cohort study from within the UK National Early Inflammatory Arthritis audit [abstract]. Arthritis Rheumatol. 2022;74(suppl 9). https://acrabstracts.org/abstract/diagnostic-delay-and-less-intensive-therapy-for-people-with-psoriatic-arthritis-compared-with-rheumatoid-arthritis-a-nested-matched-cohort-study-from-within-the-uk-national-early-inflammatory-arthrit/. Accessed December 10, 2024. This work was supported by an unrestricted grant from Janssen. The National Early Inflammatory Arthritis Audit is commissioned by the Healthcare Quality Improvement Partnership, funded by National Health Service (NHS) England and NHS Improvement and the Welsh government and carried out by the British Society for Rheumatology, King's College London, and Net Solving. Not applicable. This study protocol was approved by the National Early Inflammatory Arthritis Audit (NEIAA) Data Access Request Review Group. The NEIAA successfully obtained a Secretary of State for Health section 2.51 approval, allowing collection of patient identifiable data without consent and a separate Research Ethics Committee (REC) approval to allow the use of data for research (Confidential Advisory Group reference: 24/CAG/0108, REC reference: 24/YH/0175). Data access requests can be made through the Healthcare Quality Improvement Partnership. Data are not available for this project as part of the data sharing agreement between the National Early Arthritis Audit and the Royal United Hospitals National Health Service foundation trust the data has been destroyed on completion of the analysis. Not commissioned; externally peer reviewed. This work was supported by an unrestricted grant from Janssen. The National Early Inflammatory Arthritis Audit is commissioned by the Healthcare Quality Improvement Partnership, funded by National Health Service (NHS) England and NHS Improvement and the Welsh government and carried out by the British Society for Rheumatology, King's College London, and Net Solving.

Funders	Funder number
National Early Arthritis Audit
Arthritis Rheumatol
National Early Inflammatory Arthritis Audit
Royal United Hospitals National Health Service foundation
Heart of England NHS Foundation Trust
Janssen Pharmaceutica NV
British Society for Rheumatology
National Health Service
King's College London
Net Solving	24/CAG/0108, 24/YH/0175
National Health Service Corps
Janssen Pharmaceutica

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Charlton, R., Gates, E., Coates, L., Galloway, J., McHugh, N., McGrogan, A., Hackett, S., Brooke, M., Cavill, C., & Tillett, W. (2025). Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set. Annals of the Rheumatic Diseases, 84(6), 970-978. https://doi.org/10.1016/j.ard.2025.02.020

Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set. / Charlton, Rachel; Gates, Emer; Coates, Laura et al.
In: Annals of the Rheumatic Diseases, Vol. 84, No. 6, 06.2025, p. 970-978.

Research output: Contribution to journal › Article › peer-review

Charlton, R, Gates, E, Coates, L, Galloway, J, McHugh, N , McGrogan, A, Hackett, S, Brooke, M, Cavill, C & Tillett, W 2025, 'Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set', Annals of the Rheumatic Diseases, vol. 84, no. 6, pp. 970-978. https://doi.org/10.1016/j.ard.2025.02.020

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title = "Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set",

abstract = "Objectives: This study aimed to compare time to diagnosis among patients with psoriatic arthritis (PsA) with that of patients with rheumatoid arthritis (RA) and compare initial treatment and outcomes. Methods: Patients with PsA were identified from the National Early Inflammatory Arthritis Audit between May 2018 and October 31, 2019, and matched to patients with RA (1:1) on age and sex. Patient characteristics and time to diagnosis were compared between PsA and RA groups. Further comparisons were made, restricted to matched pairs of patients with polyarticular PsA, including disease activity, disease impact, and treatment initiation. Results: In total, 2120 patients with PsA were matched to patients with RA, of which 1250 had polyarticular disease. Symptom duration before referral was longer in patients with PsA than that in patients with RA. Patients with PsA had a longer time from general practitioner (GP) presentation to diagnosis (mean, 112 v 89 days; hazard ratio [HR], 0.87; 95\% CI, 0.79-0.96; P = .007), including a delay in diagnosis once referrals were received in secondary care (HR, 0.86; 95\% CI, 0.80-0.95; P = .002). In patients with polyarticular disease, less disease-modifying antirheumatic drugs (DMARDs) were prescribed at baseline to patients with PsA compared with those to patients with RA (54.0\% and 69.0\%, respectively; P < .001). Patients with RA had a higher Disease Activity Score in 28 joints at baseline, but by 3 months, the average score was 0.27 (95\% CI, 0.13-0.4) higher in patients with PsA. Conclusions: Compared with patients with RA, patients with PsA have a longer duration of symptoms before referral and a longer interval between presentation to the GP and receiving a diagnosis. Most people agreed a treat-to-target strategy but fewer DMARDs were commenced for patients with PsA than those for patients with RA and a lower improvement in disease activity was achieved at 3 months, suggesting undertreatment.",

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AU - Gates, Emer

AU - Coates, Laura

AU - Galloway, James

AU - McHugh, Neil

AU - McGrogan, Anita

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AU - Brooke, Melanie

AU - Cavill, Charlotte

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AB - Objectives: This study aimed to compare time to diagnosis among patients with psoriatic arthritis (PsA) with that of patients with rheumatoid arthritis (RA) and compare initial treatment and outcomes. Methods: Patients with PsA were identified from the National Early Inflammatory Arthritis Audit between May 2018 and October 31, 2019, and matched to patients with RA (1:1) on age and sex. Patient characteristics and time to diagnosis were compared between PsA and RA groups. Further comparisons were made, restricted to matched pairs of patients with polyarticular PsA, including disease activity, disease impact, and treatment initiation. Results: In total, 2120 patients with PsA were matched to patients with RA, of which 1250 had polyarticular disease. Symptom duration before referral was longer in patients with PsA than that in patients with RA. Patients with PsA had a longer time from general practitioner (GP) presentation to diagnosis (mean, 112 v 89 days; hazard ratio [HR], 0.87; 95% CI, 0.79-0.96; P = .007), including a delay in diagnosis once referrals were received in secondary care (HR, 0.86; 95% CI, 0.80-0.95; P = .002). In patients with polyarticular disease, less disease-modifying antirheumatic drugs (DMARDs) were prescribed at baseline to patients with PsA compared with those to patients with RA (54.0% and 69.0%, respectively; P < .001). Patients with RA had a higher Disease Activity Score in 28 joints at baseline, but by 3 months, the average score was 0.27 (95% CI, 0.13-0.4) higher in patients with PsA. Conclusions: Compared with patients with RA, patients with PsA have a longer duration of symptoms before referral and a longer interval between presentation to the GP and receiving a diagnosis. Most people agreed a treat-to-target strategy but fewer DMARDs were commenced for patients with PsA than those for patients with RA and a lower improvement in disease activity was achieved at 3 months, suggesting undertreatment.

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Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set

Abstract

Data Availability Statement

Funding

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