Diagnostic delay in the early phase of psoriatic arthritis is independently associated with adverse pain-related cognitive responses: a multicentre cross-sectional study

Objective: Diagnostic delay during the early phase of psoriatic arthritis (PsA) is associated with worse long-term outcomes. Thus, early recognition remains crucial. Whether the delayed recognition of early PsA is associated with adverse pain-related cognitive responses has not been investigated. We examined the association between diagnostic delay, time to first biologic or targeted synthetic DMARD (b/tsDMARD) initiation, and pain-related cognitive burden in a multicentre cohort of patients with PsA. Methods: We conducted a multicentre cross-sectional study within three Italian referral centres for PsA. Adverse pain-related cognitive responses were investigated using the Pain Catastrophizing Scale (PCS), which captures the domains of rumination, magnification and helplessness. A total PCS score ≥ 30 was used as cut-off to define PCS-defined pain impairment. We defined: diagnostic delay as the lag time between symptoms onset and confirmed PsA diagnosis; therapeutic delay as the interval between PsA diagnosis and first b/tsDMARD initiation. Clinical, laboratory and patient-reported variables were compared according to PCS status. Multivariable logistic regression analysis was used to identify factors independently associated with pain catastrophizing. Results: Among 207 patients, 31.4% had PCS ≥30. Patients with PCS-defined impairment had significantly higher pain VAS, patient global assessment, evaluator global assessment, tender joint count, swollen joint count, ESR, DAPSA, BASDAI and ASDAS-CRP scores. Higher WPI, SSS and BDI scores were also reported amongst those with PCS ≥30. Diagnostic delay ≥6 months and therapeutic delay were observed to be more frequent in patients with PCS ≥30 (p=0.017 and p=0.045 respectively). Patients with delayed diagnosis had significantly higher PCS total score and within the subdomains of rumination, magnification and helplessness. The multivariable analysis showed the independent association of the diagnostic delay with PCS ≥30 (OR 3.65, 95% CI 1.21-11.02). Conclusion: Delayed recognition in the early phase of PsA is independently associated with adverse pain-related cognitive burden, as defined by the Pain Catastrophizing Scale.