Individuals with psoriatic arthritis (PsA) experience significantly longer delays to diagnosis and are less likely to receive early disease-modifying antirheumatic drug (DMARD) therapy compared to matched patients with rheumatoid arthritis (RA), according to a new study.
Using national audit data from England and Wales, the analysis of 2,120 matched pairs showed that patients with PsA waited longer to present to their GP after symptom onset. They also had a slower time to diagnosis after referral to rheumatology, highlighting the need for greater awareness among both patients with psoriasis and healthcare professionals.
Reduced improvement three months for PsA
The study also found that only 54% of patients with polyarticular PsA were prescribed a DMARD at baseline versus 69% of those with RA (p < .001). Methotrexate monotherapy was more common in PsA, while a higher proportion of RA patients were prescribed corticosteroids. At three months, PsA patients showed smaller reductions in disease activity than their RA counterparts, despite having similar disease burden at baseline.
Although over 80% in both groups agreed a treat-to-target strategy, fewer PsA patients were prescribed corticosteroids at baseline (47.6% vs 75.8%, p < .001), and fewer received disease-specific education (93.5% vs 96.2%, p = .021).
The researchers said that the findings point to an underutilisation of available therapeutic options in PsA care, which risks permanent damage to patients’ joints.
Dr William Tillett, study lead and consultant rheumatologist at the Royal National Hospital for Rheumatic Diseases at the Royal United Hospitals Bath NHS Foundation Trust, said: ‘Work from our group and other researchers shows that delays to diagnosis of just six months can result in worse physical function for a patient in 10 years’ time, so diagnosing and treating the disease early, to prevent structural damage and preserve function, is vitally important.’
Real-world impact on function and quality of life
The findings confirmed that PsA is not only diagnosed later than RA but also managed less aggressively in its early stages – despite comparable disease burden. The researchers concluded that improved patient and clinician education, faster diagnostic pathways, and earlier access to combination therapies are required.
Commenting on the impact of their findings, Dr Rachel Charlton, research fellow in the Department of Pharmacy & Pharmacology at the University of Bath and the study’s first author, said: ‘We need more education around clinicians assessing people with arthritic symptoms and better access to scans. We also need to focus on early intensive treatment before damage sets in – there is a window of opportunity that we may be missing.’
Failure to do this contributes to poorer short-term outcomes and may increase long-term disability risk for PsA patients.
Reference
Charlton RA et al. Diagnostic delay and less intensive therapy for people with psoriatic arthritis compared with rheumatoid arthritis: a study nested within an English and Welsh audit data set. Ann Rheum Dis 2025;00:1–9.
