Psoriasis May Be Underdiagnosed Among Patients With Axial Spondyloarthritis

Use of a self-reported questionnaire that includes representative images of psoriasis symptoms may be advantageous for identifying patients with axial spondyloarthritis (axSpA) who have undiagnosed psoriasis, according to study results published in Arthritis Research & Therapy.

Investigators assessed the prevalence of psoriasis in self-reported questionnaires vs confirmed physician diagnoses among patients with axSpA.

An observational study was conducted, including patients from the Dutch Groningen Leeuwarden Axial Spondyloarthritis cohort. Patients were asked to fill out a self-screening psoriasis questionnaire. Prevalence rates of self-reported psoriasis were then compared with those verified by diagnoses recorded in clinical records.

A total of 448 survey responses were included in the analysis. Of these, 341 patients were diagnosed with ankylosing spondylitis and 90 were diagnosed with nonradiographic axSpA. Sub-classification data was not available for the remaining 17 patients.

Mean patient age was 50.1±12.7 years and 64.1% of the study population were men. Additionally, a total of 78.5% of patients showed positive markers for human leukocyte antigen B27. The average Ankylosing Spondylitis Disease Activity Score was 2.2±1.0.

A total of 58 patients (13.0%) self-reported psoriasis symptoms. Psoriasis diagnosis was confirmed by medical records in 28 out of 58 patients (48.0%), indicating a prevalence rate of 6.3%.

Patients who reported psoriasis symptoms without a confirmed diagnosis experienced more mild vs moderate to severe symptoms compared against those with a verified diagnosis (25.0% vs 3.0%; P =.02). These patients also had fewer psoriasis lesions on the torso area (3.0% vs 18.0%; P =.04), intergluteal cleft (0.0% vs 25.0%; P =.02), and legs (7.0% vs 43.0%; P <.01).

Among the 31 patients with axSpA who reported having active psoriasis, 74.0% experienced mild symptoms.

This study was limited by the strict use of self-reported questionnaires to gather data.

The study authors concluded, “Psoriasis seems to be underdiagnosed in axSpA patients, although psoriasis, which is an extra-skeletal manifestation (ESM) of axSpA, may contribute to the diagnosis and to the pharmacological treatment decision of axSpA.”

Disclosure: Multiple study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Rheumatology Advisor