AB0947 Impact of clinical specialty setting on disease management in patients with psoriatic arthritis: results from a cross-sectional observational study in the united states
Authors: P.J. Mease, B. Lockshin, C. Liu, E. Siegel, L. Chen, X. Bu, X. Wang, K. Douglas
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Early diagnosis and effective treatment has been shown to decrease functional disability and structural progression in patients (pts) with psoriatic arthritis (PsA).<sup>1</sup> However, factors that influence treatment management decisions are poorly understood. <h3>Objectives</h3> To evaluate the impact of clinical specialty setting on the management of US pts with PsA. <h3>Methods</h3> LOOP was a multi-centre, cross-sectional observational study conducted across 44 sites in US. Adult pts with a suspected or an established diagnosis of PsA who were routinely visiting a rheumatologist (rheum) or a dermatologist (derm) were eligible to participate in this study. Each enrolled pt was assessed by both rheum and derm. The association between enrolling or diagnosing clinical specialty setting and time from symptom onset to PsA diagnosis and to different disease management steps were examined. <h3>Results</h3> Of 681 pts enrolled, 513 pts with a confirmed diagnosis of PsA were included in this analysis. PsA diagnosis was established prior to study entry in 404 pts (established pts), while diagnosis was confirmed during the study in 109 pts (suspected pts). In established pts, PsA was first diagnosed in 352 (87.1%) pts by a rheum and 40 (9.9%) pts by a derm. Among suspected pts, 87 (79.8%) and 15 (13.8%) pts were being managed by derm and rheum setting, respectively. Pt demographics and disease characteristics were comparable between PsA pts enrolled by rheum and derm setting. Current disease activity and disease burden were also mostly similar between rheum and derm setting (table 1); though pts enrolled in derm setting had higher scores on skin measures and enthesitis. The median (95% CI) time from symptom onset to PsA diagnosis was 1.0 (0.5, 1.1) and 2.6 (1.7, 4.1) years (y) in pts enrolled in rheum and derm setting, respectively (p&lt;0.001). However, the median time to PsA diagnosis was 0.9 (0.5, 1.0) and 1.0 (0.0, 2.0) y in pts diagnosed by rheums and derms, respectively. After PsA diagnosis, the median time to first csDMARD and to first bDMARD was 1.0 and 2.4 y, respectively. Overall, 282 (55.0%) and 354 (69.0%) pts received csDMARDs and bDMARDs, respectively. Treatment with first csDMARD occurred in 106 (20.7%) pts before PsA diagnosis and 176 (34.3%) pts after diagnosis; for first bDMARD, it was 121 (23.6%) and 233 (45.4%) pts, respectively. <h3>Conclusions</h3> The duration from symptom onset to PsA diagnosis was longer in pts enrolled by derms and was similar in pts diagnosed by both rheums and derms. The median time was longer for treatment with first bDMARD compared with first csDMARD. Current disease activity and disease burden highlight the delay in PsA diagnosis and the need for appropriate management of PsA pts, irrespective of clinical specialty setting. <h3>Reference</h3> [1] Gladman DD, et al., Ann Rheum Dis, 2011; 70:2152–4. <h3>Acknowledgements</h3> AbbVie funded the LOOP study, contributed to its design, and participated in data collection, analysis and interpretation of the data, and in writing, review, and approval of the publication. AbbVie and the authors thank all study investigators for their contributions and the patients who participated in this study. Medical writing: Deepa Venkitaramani, PhD, of AbbVie. <h3>Disclosure of Interest</h3> P. Mease Grant/research support from: AbbVie, Amgen, Bristol Myers, Celgene, Genentech, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Consultant for: AbbVie, Amgen, Bristol Myers, Celgene, Genentech, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, Speakers bureau: AbbVie, Amgen, Bristol Myers, Celgene, Genentech, Janssen, Leo, Lilly, Merck, Novartis, Pfizer, Sun Pharma, and UCB, B. Lockshin Grant/research support from: Abbvie, Abbott, Amgen, Eli Lilly, Janssen, and Sun Pharma, Consultant for: Abbvie, Abbott, Amgen, Eli Lilly, Janssen, and Sun Pharma, Speakers bureau: Abbvie, Abbott, Amgen, Eli Lilly, Janssen, and Sun Pharma, C. Liu Grant/research support from: AbbVie, Speakers bureau: AbbVie, Celgene, Eli Lilly, Janssen, Novartis, Pfizer, Regeneron, and Sanofi Genzyme, E. Siegel Grant/research support from: AbbVie, Amgen, Celgene, Janssen, Lilly, and Sanofi, Consultant for: AbbVie, Amgen, Celgene, Janssen, Lilly, and Sanofi, Speakers bureau: AbbVie, Amgen, Celgene, Janssen, Lilly, and Sanofi, L. Chen Shareholder of: AbbVie, Employee of: AbbVie, X. Bu Shareholder of: AbbVie, Employee of: AbbVie, X. Wang Shareholder of: AbbVie, Employee of: AbbVie, K. Douglas Shareholder of: AbbVie, Employee of: AbbVie