Screening Tool Identifies Psoriatic Arthritis in Patients With Psoriasis

Use of the validated Psoriasis Epidemiology Screening Tool (PEST), which includes 5 separate questions, identified >10% of patients enrolled in the US-based Corrona Psoriasis Registry as having PEST scores of ≥3, raising the possibility that these individuals with psoriasis (PsO) may have undiagnosed psoriatic arthritis (PsA) as well.  This underscores the need for improved screening for PsA in dermatology settings, according to study results published in the Journal of the European Academy of Dermatology and Venereology.

The investigators sought to evaluate the risk for possible undiagnosed PsA in patients with PsO and to characterize patients according to their PEST scores. A cross-sectional analysis was conducted from the Corrona Psoriasis Registry — a large, independent, prospective, observational cohort of patients with PsO, which was launched in April 2015.

Patients in the current analysis were recruited from 114 private and academic practice sites across the United States, with 263 practicing dermatologists involved. The mean time of patient follow-up was 1.36 years (median, 1.28 years). All participants were age ≥18, had been diagnosed with PsO by a dermatologist, and had initiated or switched to a systemic (biologic or nonbiologic) PsO treatment on the date of enrollment or ≤12 months prior to enrollment.

As of May 10, 2018, a total of 4864 patients had been enrolled through the Corrona Psoriasis Registry, with data available on 11,562 patient-visits and 3890.8 patient-years of follow-up observation. Mean patient follow-up time was 1.36 years, with a median follow-up of 1.28 years.

Data were obtained via questionnaires from patients and treating dermatologists regarding: (1) patient demographics, including age, gender, race/ethnicity, body mass index (BMI), body weight, history of comorbidities, work status, smoking status, and family history of PsO; (2) treatment history, including past and current use of biologic and nonbiologic systemic treatments; (3), clinical characteristics, including psoriasis morphology, body surface area (0% to 100%) affected, Investigator Global Assessment (0 to 4), and Psoriasis Area and Severity Index (0 to 72); (4) patient-reported outcomes, including patient-reported pain and fatigue Visual Analog Scale (VAS, 0 to 100), Dermatology Life Quality Index (DLQI, 0 to 30), and EuroQoL VAS (EQ VAS, 0 to 100); and (5) work productivity, assessed by the Work Productivity and Activity Impairment questionnaire.

Patients with PEST scores ≥3 and patients with scores <3 were evaluated. Of a total of 1516 individuals with PsO, 904 did not have dermatologist-reported PsA. Overall, (112 of 904) of these patients (12.4%) had PEST scores of ≥3. These individuals were significantly older (P =.016), were more likely to be women (P =.012), less likely to have a full- or part-time job (P <.001), and more likely to have a higher BMI (P =.001) compared with individuals with PEST scores <3. Moreover, participants with a PEST score of ≥3 were also significantly more likely to have certain comorbidities and a family history of PsO compared with patients with PEST scores <3 (P <.05 for all).

In addition, patients with a PEST score ≥3 had a significantly longer duration of PsO than patients with a PEST score <3 (17.3 vs 14.6 years, respectively; P <.001). Moreover, patients with PEST scores ≥3 were more likely than patients with PEST scores <3 to exhibit nail PsO.

Of the 904 participants without dermatologist-reported PsA, participants with a PEST score ≥3 had significantly worse pain and fatigue compared with patients with a PEST score <3 (P =.015 and P <.001, respectively). Patients with PEST scores ≥3 also demonstrated significantly worse mean health status on the EQ VAS and DLQI score (P =.002 for both). Regarding the Work Productivity and Activity Impairment (WPAI) questionnaire, patients with a PEST score ≥3 had significantly worse mean activity impairments than patients with a PEST score <3 (P <.001).

The investigators concluded that the appropriate and earlier care of patients with possible undiagnosed PsA is important, because these individuals are more likely to have nail PsO, worse health-related quality of life, and higher levels of activity impairment.

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Reference

Mease PJ, Palmer JB, Hur P, et al. Utilization of the validated Psoriasis Epidemiology Screening Tool (PEST) to identify signs and symptoms of psoriatic arthritis among those with psoriasis: a cross-sectional analysis from the US-based Corrona Psoriasis Registry [published online January 21, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15443