Pos0879 the impact of 6-month delay in diagnosis on clinical and functional status in the psa patients under bdmard treatment: results from treasure database

Background The impact of delay in diagnosis on the disease severity and functional loss has been shown previously In Psoriatic arthritis (PsA) patients. Objectives This study aimed to evaluate the impact of 6 month-delay in diagnosis on patients` clinical outcomes and functional outcomes in the PsA patients under bDMARD therapy using a national database. Methods TReasure is a national, multicentre, longitudinal, and observational database, initiated in Turkey in 2017 and now includes 17 centres [1]. PsA patients with/out more than 6 months from the onset of symptoms to diagnosis were evaluated. Demographic characteristics of the patients (age, gender, delay in diagnosis), smoking (ever), BMI, and CCI score were calculated. PsA and associated disease characteristics; dactylitis, enthesitis, uveitis, IBD, sacroiliitis by mNY, disease activity at bDMARD initiation; SJC (66 joints), TJC (68 joints), ASDAS-CRP, ASDAS-ESR, BASDAI, ESR, CRP, VAS (physician global, patient global), function and quality of life; BASFI (>40 mm), HAQ-DI (<0.5, 0.5-1.0, >1.0), EQ5D, were assessed and compared between two groups. Results In TReasure database, the time between symptom to diagnosis was known in 865/911 (94.9%) of PsA patients. More than 6 months of delay in diagnosis was present in 627/865 (72.4%) patients. In delayed-diagnosis group time from symptom onset to initiation of bDMARD was longer (6.1 (3.3-6.1) vs 2.4 (0.8-7.1) years, p<0.001). Patients with delay in diagnosis of PsA had more sacroiliitis (57.3% vs 46.2%, p=0.014) according to mNY criteria. However, dactylitis was more common in patients with less than 6 months of delay in diagnosis (31.2% vs 19.1%, p<0.001).Patients’ ASDAS-CRP and VAS-Physician Global score were slightly higher, while other activity parameters were similar; (ASDAS-ESR, BASDAI, BASMI, VAS patient global, SJC and TJC) (Table 1). There was no difference between the median (IQR) BASFI and HAQ-DI scores in delayed-diagnosis group, whereas BASFI and HAQ-DI categories showed worse function and quality of life. EQ5D showed similar result with slightly worse scores in delayed-diagnosis group. Conclusion Approximately three-quarters of PsA patients using bDMARDs have a delay of at least 6 months in diagnosis. Delay in diagnosis significantly prolongs the time until bDMARD initiation. The most important clinical finding in earlier diagnosis group is dactylitis. Axial involvement may be a reason, perhaps the result, of the delay in diagnosis. Since the delay in diagnosis is related to poor function and quality of life, efforts should be made for early diagnosis at every stage. Reference [1]Kalyoncu U, et al. Turk J Med Sci. 2018 Aug 16;48(4):856-861. Table 1. Demographic and Clinical Characteristics of Patients with/without diagnostic delay Patients with diagnostic delay < 6 months n=238 Patients with diagnostic delay > 6 months N=627 P Current Age (y) 45 (38-57) 47 (40-57) 0.09 Gender (male) n, (%) 89 (37.4) 200 (31.9) 0.13 Delay in diagnosis, month 3.0 1.0-4.9) 24.0 (11.9-61.0) <0.001 Disease duration (symptom-bDMARD initiation) 2.4 (0.8-7.1) 6.1 (3.3-6.1) <0.001 Disease duration (diagnosis-bDMARD initiation) 2.3 (0.6-7.1) 2.5 (0.7-6.2) 0.61 BMI 28.1 (24.6-32.0) 28.0 (24.9-31.9) 0.62 Smoking (ever) 119 (50.6) 289 (47.2) 0.37 CCI (≥1), n (%) 47 (19.7) 127 (20.3) 0.62 ASDAS-CRP 3.45 (2.77-4.08) 3.62 (3.14-4.25) 0.011 BASFI Score (0-10) 4.6 (2.2-6.2) 4.7 (3.4-5.9) 0.52 BASFI category > 4 92 (61.7) 307 (71.4) 0.028 EQ5D score 11 (9-11) 11 (10-12) 0.026 HAQ-DI score 0.64 (0.40-1.0) 0.63 (0.50-0.80) 0.76 HAQ-DI category <0.5 0.5-1.0 > 1.0 37 (28.0) 58 (43.9) 37 (28.0) 68 (17.6) 241 (62.4) 77 (19.9) 0.002 VAS-Physician global 70 (50-80) 70 (60-80) 0.003 Sacroliitis according to mnY, n (%) 80 (46.2) 238 (57.3) 0.014 Dactylitis, n (%) 64 (31.2) 105 (19.1) <0.001 Continious variables were presented as median (%25-75), BMI: Body mass index (n=856), CCI: Charlson Comorbidity Index (n=865), BASFI: The Bath Acknowledgements: NIL. Disclosure of Interests None Declared.