Background: Psoriatic Arthritis (PsA) diagnosis and treatment is commonly delayed, or even missed due to the manifold of clinical presentations that patients often experience. Diagnosis delay is associated with a higher disease activity and a poorer functional outcome on PsA patients. The effect of diagnosis delay on cardiovascular (CV) risk has not been determined.
Objectives: To compare disease activity, CV risk, and prevalence of carotid plaque (CP) and increased carotid intima-media thickness (cIMT) between patients with a diagnosis delay lower or higher than one year.
Methods: We conducted an observational, comparative, and cross-sectional study on patients who fulfilled the 2006 Classification Criteria for Psoriatic Arthritis (CASPAR). Disease Activity was assessed through clinical history and blood tests. Patients´ CV risk was estimated with six different calculators: Framingham Risk Score-BMI (FRS-BMI), Atherosclerotic Cardiovascular Disease (ASCVD), QRISK3, SCORE, and the World Health Organization CV risk non-laboratory-based charts (WHO-BMI). The presence of cIMT and CP was evaluated by Carotid B- mode ultrasonography. Descriptive analyses were performed with frequencies (%), mean (± SD) and median (q25-q75), and comparisons with Chi square, Student ́s t and Mann-Whitney U test. We considered p<0.05 significative.
Results: A total of 63 patients were recruited. Patients who got a diagnosis after one year of the symptoms’ onset had significant higher disease activity measured by Disease Activity in Psoriatic Arthritis (DAPSA) score [21.52 ±16.67 vs. 12.11 ±10.58; p=0.009], by 28-Joint Disease Activity Score C-Reactive Protein (DAS28-RCP) [2.887 ±1.168 vs. 2.175 ±1.025; p=0.012], and by 28-Joint Disease Activity Score Erythrocyte Sedimentation Rate (DAS28-ESR) [4.453 ± 1.474 vs. 3.247 ± 1.284; p=0.001]. Patients with a diagnosis delay higher than one year also reported a higher pain Numerical Rating Scale (NRS) than patients without diagnosis delay [3.5 (0-10.00) vs. 3.00 (0-10.00; p=0.018]. There were no significant differences in Psoriatic Area Severity scale (PASI) or Nail Psoriasis Severity Index (NAPSI). There were no significant differences in CP and c-IMT prevalence between both groups. Patients with diagnosis delay higher than one year had significant higher risk in WHO-BMI CV risk calculator [6.88 (1.0-18.0) vs. 4.59 (1.0-13.0); p=0.034], with no significant differences between the other evaluated calculators. (Table 1)
Conclusion: Patients with a diagnostic delay above one year have a higher disease activity than those diagnosed in a shorter period, without significant differences in prevalence for CP or cIMT. Early diagnosis and intervention are imperative to improve the patient´s outcome.
Clinical and Sociodemographic Characteristics
Diagnosis in less than one year
| Diagnosis in more than one year
| p -value | |
---|---|---|---|
Age, Mean ±SD | 53.47 ±11.31 | 56.75 ±10.77 | NS |
Female, n (%) | 18 (51.42) | 17 (60.71) | NS |
Das28-CRP, Mean ±SD | 2.175 ±1.025 | 2.887 ±1.168 | 0.012 |
Das28-ECR, Mean ±SD | 3.247 ±1.284 | 4.453 ±1.474 | 0.001 |
NRS, Median (q25-q75) | 3.00 (0-10.00) | 3.5 (0-10.00) | NS |
PASI, Median (q25-q75) | 0.3 (0.00-11.8) | 1.00 (0.00-10.20) | NS |
NAPSI, Median (q25-q75) | 0.00 (0.00-65.0) | 1.00 (0.00-68.0) | NS |
DAPSA, Mean ±SD | 12.11 ±10.58 | 21.52 ±16.67 | 0.009 |
CP, n (%) | 16 (45.71) | 11 (39.28) | NS |
Increased cIMT n (%) | 6 (17.14) | 4 (14.28) | NS |
WHO-BMI, Median (q25-q75) | 4.59 (1.0-13.0) | 6.88 (1.0-18.0) | 0.034 |
FRS-BMI, Mean ±SD | 15.88 ±14.95 | 23.34 ±21.35 | NS |
ASCVD, Median (q25-q75) | 4.45 (0.70-33.20) | 12.050 (0.3-56.70) | NS |
QRISK3, Median ±SD | 5.20 (0.30-34.00) | 9.35 (0.60-39.20) | NS |
SCORE, Median (q25-q75) | 1.00 (0.00-12.00) | 2.00 (0.00-11.00) | NS |
DAS28-CRP, 28-joint Disease Activity Score C-reactive protein; Das28-ECR, 28-joint Disease Activity Score Erythrocyte Sedimentation Rate; NRS, Number Rating Scale; PASI, Psoriasis Area Severity Index; NAPSI, Nail Psoriasis Severity Index; DAPSA, Disease Activity in Psoriatic Arthritis, CP, Carotid Plaque, WHO-BMI, World Health Organization Body Mass Index; FRS-BMI, Framingham Risk Score Body Mass Index; ASCVD, Atherosclerosis Cardiovascular Disease Calculator; SD, Standard Deviation |
REFERENCES: NIL.
Acknowledgements: NIL.
Disclosure of Interests: None declared.