Dr Soumya Chakravarty Discusses Impact of Diagnostic Delays for Psoriatic Arthritis

Progress has been made regarding diagnostic delays for psoriatic arthritis, but further intervention is still warranted to address this major unmet need, said Soumya Chakravarty, MD, PhD, FACP, FACR, strategic lead, Rheumatology Therapeutic Area at Janssen.

Transcript

Although timely diagnosis of psoriatic arthritis is vital to patient outcomes, diagnostic delay is common for the condition. Can you discuss the impact of time to diagnosis for patients and current methods of screening?

You've really touched upon a very important issue, because unfortunately, what happens is that people living with psoriatic arthritis can have this for years before actually receiving an accurate diagnosis, and with that, the proper treatment plan through shared decision-making.

Unfortunately, we've actually been able to see some recent research that's highlighted this again and again, that there's multiple-year delays from symptom onset to actually having a diagnosis. And this is primarily due to the fact that there's no singular definitive test for psoriatic arthritis and that psoriatic arthritis is a very heterogeneous disease, which means that it can present in different ways that involve some of the things that we've already talked about, like skin disease or peripheral arthritis.

But then also enthesitis, which is again, inflammation of tendons or ligaments in certain bones; dactylitis, which is that soft tissue inflammation around the joints; axial disease, so involvement of the spine and sacroiliac joints; nail disease. So, there's that heterogeneity of disease with psoriatic arthritis that makes it a challenge to diagnose. So, because of that issue there, we have found, unfortunately, that there are delays in diagnosis.

But at the same time, I think we've come a long way in terms of being able to recognize that there are screening tools that we can use to be able to try and detect psoriatic arthritis a little bit earlier—those patients with psoriasis. So, there's actually a tool called the PEST, which is the Psoriasis Epidemiology Screening Tool—actually a validated screening tool that can aid in PsA [psoriatic arthritis] diagnosis.

Then we actually have the gold standard for diagnosis now, which is called the CASPAR [Classification Criteria for Psoriatic Arthritis] and that is really our opportunity to take into account inflammatory articular disease, as well as a point-based system that incorporates any skin involvement, negative rheumatoid factor, nail disease, dactylitis, any X-ray changes—to really then be able to confirm that the patient has psoriatic arthritis based on that CASPAR criteria.

So, I would say that there has certainly been progress made in terms of being able to diagnose patients sooner rather than later, but I do believe that it's still an area of unmet need—we can always do better. And of course, there's consequences for delayed diagnoses, along with other challenges that can lead to undertreatment, and of course, patients are continuing to suffer their painful symptoms that can be difficult to manage and continue to progress without early diagnosis and treatment.