Management and Treatment Patterns in Psoriasis and Psoriatic Arthritis

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Among patients with psoriasis (PSO), the diagnosis and treatment patterns of psoriatic arthritis (PsA) differ depending on the managing-physician's specialty. ObjectivesTo estimate the incidence of, time to, and factors associated with PsA diagnosis after incident PSO diagnosis.To evaluate the disease management pattern, by physician specialty, 1 year before and after incident PsA diagnosis among patients with PSO and PsA. Methods• Data were extracted from the HealthVerity Claims, Pharmacy, and Electronic Medical Record (EMR) database, from November 2015-August 2022, for insured patients (≥18 years) living in the US.• Eligible patients had a 365 day baseline period with continuous medical coverage prior to index date (PSO cohort: incident PSO diagnosis; PSO/PsA cohort: incident PsA diagnosis). PSO Cohort• Patients with incident PSO were followed until PsA diagnosis (2 medical claims or EMR diagnoses associated with PsA ICD-10-CM codes 30-364 days apart), disenrollment, or end of data availability (Figure 1).• Rheumatologist-diagnosed PsA: either medical claim/EMR diagnosis attributed to a rheumatologist; dermatologist-diagnosed PsA: either medical claim/EMR diagnosis attributed to a dermatologist and neither to a rheumatologist; PsA diagnosed by other specialists: neither medical claim/EMR diagnosis attributed to a dermatologist nor a rheumatologist.• Factors associated with PsA diagnosis were assessed via Cox proportional hazards regression. PSO/PsA Cohort• Patients with dermatologist-managed PSO (≥1 PSO ICD-10-CM code attributed to a dermatologist) at baseline and incident PsA diagnosis were followed up to 1 year after diagnosis, disenrollment, or end of data availability (Figure 2).• Co-managed (dermatologist/rheumatologist) PsA: PsA diagnosed by a rheumatologist at index date or followup, or PSO claim made by a rheumatologist at baseline; dermatologist-managed PsA: PsA diagnosed by a dermatologist at index or follow-up and no diagnosis attributed to a rheumatologist.• Characteristics (treatment patterns, healthcare resource use [HCRU], and symptoms) 1 year before and after PsA diagnosis were stratified by management type. Results PSO Cohort• In the PSO cohort (N=15,337), 639 patients (4.2%) were diagnosed with PsA during follow-up.• Overall incidence (95% confidence interval [CI]) of PsA was 15.6 (14.4,16.8) per 1,000 person-years; median (interquartile range [IQR]) days to PsA diagnosis was 262.0 (93.0, 685.0) (Figure 3).• Incidence of and time to PsA diagnosis differed by physician specialty.-There were 64/639 patients diagnosed by dermatologists and 172/639 by rheumatologists.-There were 294/639 patients diagnosed by specialists other than dermatologists and rheumatologists, especially primary physicians (134/294).• Inflammatory polyarthropathy, fibromyalgia, or uveitis before or at PSO diagnosis had the strongest association with PsA diagnosis, regardless of the diagnosing-physician's specialty (Figure 4). PSO/PsA Cohort• In the PSO/PsA cohort (N=700), 243 patients were dermatologist-managed, and 165 were co-managed by dermatologists and rheumatologists (Table 1).• Most patients with PsA diagnosed by dermatologists (n=238), were dermatologist-managed (n=233).All patients with PsA diagnosed by rheumatologists (n=146) were co-managed.

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