University of Toronto and Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
North York General Hospital, University of Toronto and Toronto Western Hospital Family Health Team-University Health Network, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2021 May;73(5):680-686. doi: 10.1002/acr.24146. Epub 2021 Apr 3.
Information about the prediagnosis period in psoriatic arthritis (PsA) is limited. The present study was undertaken to compare health care utilization related to musculoskeletal issues during a 5-year period prior to the diagnosis of PsA versus that of subjects with no prior inflammatory arthritis within a primary care setting.
We conducted a population-based, matched cohort study using electronic medical records and administrative data in Ontario, Canada. Age- and sex-matched cohorts of PsA patients and comparators from the same family physicians were assembled. Comparators were not allowed to have prior spondyloarthritis, ankylosing spondylitis, or rheumatoid arthritis billing code diagnoses. The study outcomes included health care utilization and costs related to nonspecific musculoskeletal issues during a 5-year period prior to the index date.
We studied 462 PsA patients and 2,310 matched comparators. The odds ratio (OR) related to visiting a primary care physician for nonspecific musculoskeletal issues in patients with PsA was 2.14 (95% confidence interval 1.73-2.64) in the year immediately preceding the index date and was similarly elevated up to 5 years prior. The OR related to using other musculoskeletal-related health care services, including musculoskeletal specialists visits, joint injections, joint imaging, and emergency department visits, was higher in PsA as early as 5 years preceding the index date. Total and musculoskeletal-related health care costs prior to the index date were higher for patients with PsA versus comparators.
A prodromal PsA phase characterized by nonspecific musculoskeletal symptoms may exist. Further study is needed to determine if this represents a window for earlier diagnosis of PsA.
关于银屑病关节炎（PsA）的预诊断期的信息有限。本研究旨在比较在初级保健环境中，与未发生炎症性关节炎的患者相比，在 PsA 诊断前的 5 年内，与肌肉骨骼问题相关的医疗保健利用情况。
我们使用电子病历和加拿大安大略省的行政数据进行了一项基于人群的匹配队列研究。从同一家庭医生处组建了年龄和性别匹配的 PsA 患者队列和对照组。不允许对照组有先前的脊柱关节炎、强直性脊柱炎或类风湿关节炎计费代码诊断。研究结果包括在索引日期前 5 年内与非特异性肌肉骨骼问题相关的医疗保健利用和费用。
我们研究了 462 名 PsA 患者和 2310 名匹配的对照组。在索引日期前一年，与非特异性肌肉骨骼问题就诊初级保健医生的比值比（OR）在 PsA 患者中为 2.14（95%置信区间 1.73-2.64），在索引日期前 5 年内同样升高。与使用其他肌肉骨骼相关医疗保健服务（包括肌肉骨骼专家就诊、关节注射、关节成像和急诊就诊）相关的 OR 在 PsA 中更早，早在索引日期前 5 年。与对照组相比，在索引日期之前，PsA 患者的总医疗保健费用和肌肉骨骼相关医疗保健费用更高。
可能存在以非特异性肌肉骨骼症状为特征的前驱期 PsA 阶段。需要进一步研究以确定这是否代表早期诊断 PsA 的窗口期。
