Background: There are limited real-world data on the diagnostic experiences of patients with psoriatic arthritis (PsA), including medical care sought and potential barriers to diagnosis. We aim to describe patient experiences related to receiving a PsA diagnosis. Methods: Ours was a mixed-method, 2-phase study. Phase 1 comprised concept elicitation and cognitive interviews with clinical experts and adults diagnosed with PsA to develop a cross sectional, web-based survey. US adults with a self-reported PsA diagnosis were recruited through a patient support community (CreakyJoints), an online patient research registry (ArthritisPower), and social media outreach. In Phase 2, the online survey collected data on sociodemographics, clinical symptoms, disease burden, and diagnosis history of survey respondents with PsA. Results: Of the 203 respondents included, 172 (84.7%) were female, and the mean (SD) age was 51.6 (10.8) years. The time between seeking medical attention and receiving a diagnosis was < 6 months for 69 respondents, 6 months to 4 years for 68 respondents, and ≥ 5 years for 66 respondents. Most respondents sought care from general practitioners (79.8%) and rheumatologists (66.5%). Common initial symptoms that led respondents to seek medical attention were joint pain (70.0%) and stiffness (53.7%). Among the initial symptoms that led respondents to seek care, joint pain, swollen joints, and sausage-like fingers or toes (indicating dactylitis) were more common among respondents with shorter time to diagnosis, whereas stiffness, fatigue, enthesitis (indicated by foot problems, tendon and ligament pain), and back pain were more common among respondents with longer time to diagnosis. Common misdiagnoses were psychosomatic issues (26.6%) and osteoarthritis (21.7%). Respondents with shorter times to diagnosis had lower frequencies of misdiagnosis. Conclusions: Respondents with PsA reported delays in diagnosis and misdiagnoses on their journey to a PsA diagnosis. Symptom differences, such as enthesitis and stiffness, were noted among respondents with shorter vs longer time to diagnosis. Increased understanding of diagnostic barriers may lead to earlier diagnosis and appropriate management to improve outcomes.

BackgroundIn addition to clinician assessment and laboratory tests, patient-reported outcomes (PROs) are important for managing and improving the quality of care in patients with psoriatic arthritis (PsA). The RAPID3 was originally developed for use in patients with rheumatoid arthritis, but it may be used in clinical practice to assess disease activity in patients with PsA.1 The PROMIS10 is a general (nondisease-specific) PRO instrument that measures physical, mental, and social health.2 Developed for the general population, PROMIS10 has not yet been specifically validated in PsA.ObjectivesTo evaluate the relationship between RAPID3 and PROMIS10 in patients with PsA.MethodsUS adults with a self-reported diagnosis of PsA were recruited through CreakyJoints (www.CreakyJoints.org), an online patient support community comprising patients with arthritis and arthritis-related diseases and their caregivers. Respondents completed an online survey that was designed to collect data on socio-demographics and clinical symptoms and included the RAPID3 and PROMIS10 to evaluate disease activity and health-related quality of life (HRQoL), respectively. The RAPID3 consists of three patient self-reported scores (0–10): functional impairment, pain, and patient global assessment; total scores≤3.0=near remission, 3.1 to 6.0=low disease severity, 6.1 to 12.0=moderate disease severity, and ≥12.1 = high disease severity. PROMIS10 is a 10-item survey measuring physical and mental domains; individual scores are transformed to T-score distributions normalised to the general population. PROMIS10 individual scores and global physical and mental health T-scores were stratified by RAPID3 disease severity and compared across RAPID3 severity levels using Kruskal-Wallis or ANOVA tests, respectively. Spearman’s correlation coefficient was calculated between RAPID3 total score and the PROMIS10 physical health and mental health T-scores, respectively.ResultsAmong 203 respondents, the mean (SD) age was 51.6 (10.8) years and 172 (84.7%) were female. The mean (SD) cumulative RAPID3 score was 14.7 (5.8) with mean (SD) functional impairment, pain tolerance, and patient’s global estimate scores of 3.3 (1.8), 6.0 (2.3), and 5.4 (2.5), respectively. Patients’ mean (SD) PROMIS10 global physical and mental health T-scores were 36.4 (7.3) and 40.2 (9.3), respectively. The mean individual domain scores and global T-scores worsened with increasing RAPID3 disease severity levels (all p<0.001) (table 1). PROMIS10 physical and mental health T-scores showed a strong (r s=−0.84) and moderate correlation (rs=−0.57) with RAPID3, respectively.Abstract AB0904 – Table 1PROMIS10 Scores and Impact of PsA on Work by RAPID3 Disease Activity in Patients with PsAPROMIS10, Patient-Reported Outcome Management Information System Global Health short form; RAPID3, Routine Assessment of Patient Index Data 3.* Disease severity classified by RAPID3 scores:≤3.0=near remission; 3.1 to 6.0=low severity; 6.1 to 12.0=moderate severity;≥12.1= high severity.ConclusionsRAPID3 and PROMIS10 phys...

BackgroundPsoriatic arthritis (PsA) is a heterogeneous, chronic, immune-mediated disease characterised by a range of musculoskeletal conditions including joint pain, swelling, enthesitis and dactylitis as well as skin and nail manifestations. Early diagnosis of PsA is important as shorter time to treatment may improves outcomes.1 However, PsA is often undiagnosed or misdiagnosed.2 There is limited information on the diagnostic experiences of patients with PsA, including medical care sought and potential barriers to diagnosis.ObjectivesTo determine patients’ experiences related to the diagnosis of PsA including initial symptoms experienced, medical care sought, and time to diagnosis.MethodsUS patients aged ≥18 years with a self-reported diagnosis of PsA were recruited through CreakyJoints (www.Creakyjoints.org), an online patient support community comprising patients with arthritis and arthritis-related diseases and their caregivers, and outreach through social media. Participants completed an online survey designed to collect data on socio-demographics, clinical symptoms, disease burden, and diagnosis history, including initial PsA symptoms experienced, types of health care providers seen, misdiagnoses received before a diagnosis of PsA, and time to PsA diagnosis. Survey questions were developed following analysis of qualitative interviews of patients with PsA and clinical experts, as well as a targeted literature review.ResultsOf the 203 patients included in the study, 172 (85%) were female, with a mean (SD) age of 51.6 (10.8) years; 132 patients (65%) had private insurance, 61 (30%) Medicare, and 25 (12%) Medicaid. The most common initial symptoms that led patients to seek medical attention were joint pain (142 patients [70%]), stiffness (109 [54%]), swollen joints (101 [50%]), skin rash/psoriasis (97 [48%]), and fatigue (96 [47%]). Most patients (153 [75%]) sought medical treatment within 2 years of symptom onset. During the diagnosis process, patients most commonly sought care from a general practitioner (162 [80%]), rheumatologist (135 [66%]), dermatologist (67 [33%]), orthopedist (44 [22%]), and/or podiatrist (25 [12%]). Only 8 patients (4%) reported that they had never received a misdiagnosis; common misdiagnoses were psychosomatic disease, osteoarthritis, and anxiety/depression (figure 1). Patients reported median (IQR) time since diagnosis of 6.0 (2–11.5) years. Many patients (94 [51%]) received a diagnosis of PsA ≤1 year after seeking medical attention; however, 25 (17%) and 31 (15%) patients received a PsA diagnosis ≥5 and>10 years after seeking medical attention for the first time, respectively.Abstract THU0292 – Figure 1Misdiagnoses Received Before Diagnosis of PsA (N=203). PsA, psoriatic arthritisConclusionsThis study showed that patients often had substantial delays and misdiagnoses before they received a PsA diagnosis. Increased understanding of the diagnostic barriers may lead to earlier diagnosis and appropriate treatment that may improve outcomes.References[1] Haroon M, et al. Ann Rheum Dis2015;...