Diagnostic Delay in Psoriatic Arthritis: A Population-based Study

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.

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 (NIH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. PK is supported by T32 AR56950 grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases for the Musculoskeletal Research Training Program. ADG is supported by Centers for Disease Control and Prevention, 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. P. Karmacharya, MBBS, K. Wright, MBBS, D. Bekele, MBBS, F.C. Ernste, MD, J.M. Davis III, MD, MS, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Mayo Clinic; C.S. Crowson, PhD, Division of Rheumatology, and Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota; A. Ogdie, MD, MSCE, Departments of Medicine/Rheumatology and Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; A. Duarte-García, MD, MSc, Division of Rheumatology, and Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic; M.M. Tollefson, MD, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA. AO has served as a consultant for AbbVie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Novartis, and Pfizer (< $10,000 each), and has received grants from Novartis and Pfizer to Penn and from Amgen to Forward (grants > $10,000). JMD has received consulting fees and/or honoraria from AbbVie and Sanofi-Genzyme (< $10,000 each) and research support from Pfizer. No other disclosures are relevant to this article. Address correspondence to Dr. P. Karmacharya, Division of Rheumatology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA. Email: paraskarmacharya@gmail.com. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication February 2, 2021.