From bath.ac.uk
New research from the University of Bath reveals delayed diagnosis and undertreatment of psoriatic arthritis often results in irreversible damage to joints
Delays in diagnosing and treating psoriatic arthritis – a common inflammatory disorder affecting around 200,000 people in the UK – are causing irreparable damage to people’s health. This damage could be avoided by catching the condition earlier and treating it effectively, according to research led by scientists in the Department of Life Sciences at the University of Bath.
The new study, published today in the Annals of the Rheumatic Diseases, evaluated exactly where diagnostic delays are occurring and the treatments people are receiving. The results confirm a suspicion long held by the authors: that early symptoms of psoriatic arthritis (PsA) often persist for some time before the condition is diagnosed and treated.
The researchers are calling for improved diagnostic systems to be established, where people with PsA and the doctors treating them are supported to recognise the initial phases and diagnostic scans are offered earlier. A prompt response can prevent joint damage, and reduce pain and inflammation, resulting in far better physical function and quality of life for most patients.
The study was led by Dr William Tillett, researcher at the University of Bath and a consultant rheumatologist at the Royal National Hospital for Rheumatic Diseases (RNHRD), which is based at the Royal United Hospitals trust in Bath. He said: “Work from our group and other researchers shows that delays to diagnosis of just six months can result in worse physical function for a patient in ten years’ time, so diagnosing and treating the disease early, to prevent structural damage and preserve function, is vitally important.”
He added: “This disease can have a massive impact on people’s lives and make it difficult for them to work and manage regular daily activities.”
Visible signs of PsA appear months or even years before a person develops the full-blown condition, generally giving clinicians plenty of time to intervene with appropriate treatment. However, signs are variable and can include the rash of psoriasis, joint stiffness, lower back pain, fatigue, swollen fingers and toes, and changes to the quality of finger- and toenails. These signs can easily be confused for less serious chronic conditions, leading to misdiagnoses. As a result, valuable time is often lost before a patient is referred to a specialist, leading to delays in the diagnosis and treatment of PsA.
Elaborating, Dr Tillett said: “With rheumatoid arthritis (another common arthritis), symptoms are quickly visible, so the condition is generally diagnosed without too much delay. It’s harder to detect inflammation in the joints affected by psoriatic arthritis, as these joints – such as those in the spine – are often not visible to the eye, and it takes an ultrasound to see the damage. Too often, scans don’t happen for some time after the patient starts noticing symptoms.”
For the new study, funded by Janssen Pharmaceuticals, the authors collaborated with the British Society of Rheumatology and National Early Inflammatory Arthritis Audit to evaluate people who were diagnosed with PsA between May 2018 and October 2019, and explore why there were delays in diagnosis.
The reasons were found to be multiple: people are slow to present to their GP with symptoms and once patients find their way to a specialist, there is a long wait before diagnostic tests are carried out. The reasons for the delays between seeing a specialist and undergoing a scan remain unclear. The researchers plan to investigate this issue further in future studies.
The research team believes screening people at high risk of developing psoriatic arthritis along with more streamlined diagnostic facilities are essential interventions to stop the occurrence of irreversible damage.
Dr Rachel Charlton, the study’s first author and a life sciences researcher at Bath, said: “We need more education around clinicians assessing people with arthritic symptoms and better access to scans. We also need to focus on early intensive treatment before damage sets in – there is a window of opportunity that we may be missing at the moment.”
In future work, the researchers plan to probe the experiences of patients and clinicians in the face of PsA, to develop a fuller picture of the reasons behind diagnostic delays.
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