Clinical specialty setting and geographic region may significantly affect the diagnosis and management of psoriatic arthritis (PsA), as well as disease activity and burden, according to study results published in the American Journal of Clinical Dermatology.

Patients with PsA may present to and be treated in multiple clinical settings, including rheumatology and dermatology; however, there is limited information on the factors that influence treatment management decisions for PsA. The objective of this study was to evaluate the effect of disease characteristics, clinical specialty setting, and geographic region on PsA in the United States.

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In this multicenter, cross-sectional, observational study conducted across 44 US sites, the researchers evaluated data of 513 patients aged ≥18 years with a confirmed diagnosis of PsA who were routinely visiting either a rheumatologist or dermatologist. All patients enrolled in this study were assessed by clinicians in both specialties. The primary outcomes were the time from inflammatory musculoskeletal symptom onset to PsA diagnosis, the time from PsA diagnosis to first conventional synthetic disease-modifying antirheumatic drug or to first biologic, and the time from the first conventional synthetic disease-modifying antirheumatic drug to first biologic. The secondary outcomes were current disease activity and disease burden.

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Results revealed that among the 513 patients included in the study analyses, most were recruited (71.3%) by rheumatologists, with the remaining patients recruited by dermatologists. The median time from symptom onset to PsA diagnosis was 1.2 years, with nearly one-third of patients (31.8%) waiting >4 years for a diagnosis. The median time from symptom onset to PsA diagnosis was significantly shorter for patients enrolled by rheumatologists than for those enrolled by dermatologists (1.0 vs 2.6 years; hazard ratio, 1.47; 95% CI, 1.20-1.78; P <.001).

Disease activity and disease burden were similar between patients enrolled by rheumatologists and those enrolled by dermatologists; however, compared with patients enrolled by rheumatologists, patients enrolled by dermatologists reported a significantly worse quality of life and had significantly higher skin and enthesitis scores. Geographic region was not significantly associated with time from symptom onset to diagnosis, but patients enrolled from the western regions of the US had less severe disease than those enrolled from the eastern and central regions.

There were several limitations to this study. First, the study was observational, and analyses were based on confirmation of PsA by rheumatologists only, which may not be generalizable to PsA management of all patients across the US. In addition, this study may not have fully captured information regarding complexities of patient history, including which type of specialist made the initial PsA diagnosis, length of care with a given specialist, or prior care provided by other specialties. There were some missing data in investigated parameters, which restricted sample sizes and prevented statistical comparisons for those parameters.

“Our results show that clinical specialty setting and geographic region can affect the timing and choice of disease management steps as well as disease activity and disease burden in patients with PsA in the [US],” the researchers concluded.

Disclosure: This clinical trial was supported by AbbVie. Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Mease PJ, Liu C, Siegel E, et al. Impact of clinical specialty setting and geographic regions on disease management in patients with psoriatic arthritis in the United States: a multicenter observational study. Am J Clin Dermatol. 2019;20(6):873-880.