Diagnosis and initial management in psoriatic arthritis: A qualitative study with patients

Dures, Emma; Bowen, Clive; Brooke, Mel; Lord, Jane; Tillett, William; McHugh, Neil; Hewlett, Sarah

Abstract

Objectives. PsA is an inflammatory condition that can cause pain, fatigue, swelling and joint stiffness.
The consequences include impaired physical function, a high psychosocial burden, reduced quality of life and work disability. The presenting symptoms can be non-specific and varied, leading to
delays in diagnosis or referral to specialist teams. The aim of this study was to explore patients’ experiences of being diagnosed and the initial management of PsA.

Methods. The study used a qualitative design, with data collected in one-to-one, face-to-face semistructured interviews.

Results. Fifteen newly diagnosed patients (less than 24 months) from three hospital sites in the southwest of England participated. Interviews were transcribed, anonymized and analysed using inductive thematic
analysis. The following two main themes with sub-themes represent the data: symptom onset to specialist care: ‘it was the blind leading the blind’ (making sense of symptoms; mis-diagnosis and missed
opportunities; and fast and easy access to expertise); and diagnosis as a turning point: ‘having somebody say you’ve got something wrong with you, I was euphoric’ (validation and reassurance; weighing
up treatment options; taking on self-management; and acknowledging loss and change).

Conclusion. Participants were already dealing with functional limitations and were highly distressed and anxious by the time they received their diagnosis. Physical and mental outcomes could be improved by the implementation of existing psoriasis management guidelines and strategies for earlier referral from primary care to rheumatology and by the development of guidelines on educational, selfmanagement and psychological support provision soon after diagnosis.

• Journal Article Type: Article
• Acceptance Date: Jul 8, 2019
• Online Publication Date: Aug 26, 2019
• Publication Date: Aug 26, 2019
• Deposit Date: Oct 16, 2019
• Publicly Available Date: Oct 17, 2019
• Journal: Rheumatology Advances in Practice
• Print ISSN: 2514-1775
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 3
• Issue: 2
• Article Number: rkz022
• DOI: https://doi.org/10.1093/rap/rkz022
• Keywords: qualitative, diagnosis, psoriatic arthritis, rheumatology, specialist care, psychological distress, self-management, treatment decisions.
• Public URL: https://uwe-repository.worktribe.com/output/2715262