There is a scarcity of data on the variables that impact therapy management decisions in psoriatic arthritis (PsA). Our goal was to assess the influence of clinical specialty setting and geographic location on the management of PsA patients in the United States. LOOP was a multicenter, cross-sectional, observational research that took place across 44 locations in the United States. Patients were 18 years old and had a suspected or proven diagnosis of PsA, and they saw a rheumatologist or dermatologist on a regular basis. All research participants were evaluated by both a rheumatologist and a dermatologist. The primary outcomes were the time from symptom onset to PsA diagnosis, the time from PsA diagnosis to the first conventional synthetic disease-modifying antirheumatic medication (csDMARD), the time from PsA diagnosis to the first biologic DMARD, and the time from first csDMARD to first bDMARD. The research included 681 individuals, 513 of whom had a confirmed diagnosis of PsA and were included in this analysis. Rheumatologists recruited more patients than dermatologists. Patients included by rheumatologists had a substantially shorter median time from symptom start to diagnosis of PsA than those enrolled by dermatologists. In general, disease activity and burden were comparable among enrolling specialities. Patients in western parts of the United States, on the other hand, had less severe illness than those in central or eastern locations, as measured by joint involvement, enthesitis, and dactylitis.
In this research group, there was a considerable delay between symptom onset and diagnosis, which was considerably greater for patients enrolled in dermatology vs rheumatology. This reinforces the need of cross-specialty teamwork in detecting and treating PsA as soon as possible.