Diagnostic delay in psoriatic disease: cutaneous and musculoskeletal pathways in a Mexican tertiary-care cohort.

introductionPsoriatic disease (PsD) is frequently diagnosed late. Understanding its cutaneous and musculoskeletal diagnostic pathways is crucial for improving early recognition.

objectivesTo describe and compare the cutaneous and musculoskeletal diagnostic pathways in patients with PsD, identify factors associated with diagnostic delay, and analyze trends in time to diagnosis by pathway.

methodsCross-sectional study using a structured questionnaire. Time to diagnosis was defined separately for the cutaneous and musculoskeletal pathways, from symptom onset to the first physician-confirmed diagnosis of psoriasis (Pso) or psoriatic arthritis (PsA). Diagnostic delay was defined as time to diagnosis > 12 months. Logistic and linear regression models assessed associated factors and temporal trends.

resultsWe included 143 patients with PsD: 54 had Pso without PsA at cohort entry, and 89 had rheumatologist-confirmed PsA. Median time to diagnosis was 12.2 months in both pathways; diagnostic delay occurred in 58% of the cutaneous and 61.8% of the musculoskeletal pathways. In the cutaneous pathway, longer time to seek care increased the odds of delay, whereas a correct diagnosis at the first visit was protective. In the musculoskeletal pathway, older age and longer time to seek care increased the odds of delay, while specialist evaluation and DMARD initiation at first visit were protective. A more recent calendar year of symptom onset was associated with shorter time to diagnosis in both pathways.

conclusionsDiagnostic delays in PsD persist despite recent improvements. Distinct determinants across the cutaneous and musculoskeletal pathways highlight the need for earlier Pso recognition and more efficient referral for musculoskeletal symptoms suggestive of PsA. Keypoints • In this tertiary PsD cohort, the median time to diagnosis was 12 months in both the cutaneous and musculoskeletal diagnostic pathways, and more than half of the patients experienced delays >12 months. • In the cutaneous pathway, the main driver of delay was the time patients waited before seeking medical attention for skin lesions, whereas correct diagnosis at the first visit was protective. • In the musculoskeletal pathway, older age and delayed consultation for musculoskeletal symptoms were associated with longer delays, whereas early specialist assessment and DMARD initiation characterized more efficient pathways. • Time to diagnosis decreased significantly across calendar years in both pathways, although the persistently high delay burden underscores the need for stronger coordination among primary care, dermatology, and rheumatology.