Increased Musculoskeletal Surgery Rates During Diagnostic Delay in Psoriatic Arthritis: A Retrospective Cohort Study

Background/Objectives: Delayed diagnosis in psoriatic arthritis (PsA) is associated with significant health consequences. We hypothesize that musculoskeletal (MSK) surgery rates may be higher during the diagnostic delay period. This study aimed to compare the frequency of MSK surgeries in PsA patients during the period of diagnostic delay with the frequency of MSK surgeries post-diagnosis. Methods: This retrospective cohort study included PsA patients who fulfilled CASPAR criteria and were followed up in our outpatient clinic. PsA patients fulfilling the CASPAR criteria and followed in our outpa-tient clinic were included. The pre-diagnosis symptomatic period was considered as the period of diagnostic delay. Data on MSK surgeries were obtained from patient records. The annual number of surgeries was calculated separately for the diagnostic delay and post-diagnosis periods. Results: The study included 84 PsA patients. The mean diagnos-tic delay in PsA patients was 7.49 years. During this period, 27.4% of patients under-went at least one MSK surgery. The mean annual number of MSK surgeries was signifi-cantly higher during the diagnostic delay period compared to the post-diagnosis period (P = 0.001). Conclusion: Following PsA diagnosis, a reduction in MSK surgery rates was observed compared to the diagnostic delay period. This suggests that inflammatory symptoms in PsA patients, which could have been managed with medical therapy, may have led to avoidable MSK surgeries. Our findings highlight the need for early diagnosis to prevent unnecessary surgical interventions.