Research ArticleAccepted Article
Open Access
Diagnostic Delay in Psoriatic Arthritis: A Population Based Study
Paras Karmacharya, Kerry Wright, Sara J. Achenbach, Delamo Bekele, Cynthia S. Crowson, Alexis Ogdie, Alí Duarte-García, Floranne C. Ernste, Megha M. Tollefson and John M. Davis III
The Journal of Rheumatology February 2021, jrheum.201199; DOI: https://doi.org/10.3899/jrheum.201199
Paras Karmacharya
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Kerry Wright
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Sara J. Achenbach
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Delamo Bekele
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Cynthia S. Crowson
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Alexis Ogdie
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Alí Duarte-García
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Floranne C. Ernste
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Megha M. Tollefson
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
John M. Davis III
Division of Rheumatology, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN; Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Departments of Dermatology and Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN. Financial support: This study was made possible using the resources of the Rochester Epidemiology Project, which is supported by the National Institute on Aging of the National Institutes of Health under Award Number R01AG034676, and Grant Number UL1 TR002377 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Paras Karmacharya is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. Alí Duarte-García is supported by CDC (grant number U01 U01DP006491), the Rheumatology Research Foundation Scientist Development Award, the Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, the Women's Health Career Enhancement Award and the Eaton Family Career Development Award. Conflict of interest: Dr. Ogdie has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (less than 10,000 each) and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants more than 10,000). Dr. Davis has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (less than $10,000 each) and research support from Pfizer. No other disclosures relevant to this article. Corresponding author: Paras Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W. Rochester, MN 55905. Email: paraskarmacharya@gmail.com
Abstract
Objective To examine demographic and clinical characteristics associated with diagnostic delay in psoriatic arthritis (PsA).
Methods We characterized a retrospective, population-based cohort of incident adult (≥18 years) PsA patients from Olmsted County, MN from 2000-17. All patients met classification criteria. Diagnostic delay was defined as the time from any patient-reported PsA-related joint symptom to a physician diagnosis of PsA. Factors associated with delay in PsA diagnosis were identified through logistic regression models.
Results Of the 164 incident PsA cases from 2000-17, 162 had a physician or rheumatologist diagnosis. Mean (SD) age was 41.5 (12.6) and 46% were females. Median time from symptom onset to physician diagnosis was 2.5 years (interquartile range: 0.5 to 7.3). By six months, 38 (23%) received a diagnosis of PsA, 56 (35%) by one year and 73 (45%) by two years after symptom onset. No significant trend in diagnostic delay was observed over calendar time. Earlier age at onset of PsA symptoms, higher body mass index, and enthesitis were associated with a diagnostic delay of >2 years, while sebopsoriasis was associated with a lower likelihood of delay.
Conclusion In our study, more than half of PsA patients had a diagnostic delay of >2 years, and no significant improvement in time to diagnosis was noted between 2000-17. Patients with younger age at PsA symptom onset, higher BMI, or enthesitis before diagnosis were more likely to have a diagnostic delay of >2 year while patients with sebopsoriasis were less likely to have a diagnostic delay.
In this issue
The Journal of Rheumatology
Vol. 52, Issue 7
1 Jul 2025
Accepted manuscript
Diagnostic Delay in Psoriatic Arthritis: A Population Based Study
Paras Karmacharya, Kerry Wright, Sara J. Achenbach, Delamo Bekele, Cynthia S. Crowson, Alexis Ogdie, Alí Duarte-García, Floranne C. Ernste, Megha M. Tollefson, John M. Davis
The Journal of Rheumatology Feb 2021, jrheum.201199; DOI: 10.3899/jrheum.201199
Accepted manuscript
Diagnostic Delay in Psoriatic Arthritis: A Population Based Study
Paras Karmacharya, Kerry Wright, Sara J. Achenbach, Delamo Bekele, Cynthia S. Crowson, Alexis Ogdie, Alí Duarte-García, Floranne C. Ernste, Megha M. Tollefson, John M. Davis
The Journal of Rheumatology Feb 2021, jrheum.201199; DOI: 10.3899/jrheum.201199
