Diagnostic Delay in Psoriatic Arthritis: A Population Based Study

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

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

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

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

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

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

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

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

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

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