Comparative performance of psoriatic arthritis screening tools in patients with psoriasis in European/North American dermatology clinics - 17/09/14
, Dafna D. Gladman, MD c, Philip Helliwell, MD, PhD d, Majed M. Khraishi, MD e, Joanne Fuiman, MS f, Eustratios Bananis, PhD f, Daniel Alvarez, MD fAbstract |
Background |
General practitioners/dermatologists may be aware of musculoskeletal symptoms in patients with psoriasis but may have difficulty accurately detecting psoriatic arthritis (PsA).
Objective |
We sought to evaluate 3 PsA screening questionnaires–the Psoriasis and Arthritis Screening Questionnaire (PASQ), Psoriasis Epidemiology Screening Tool (PEST), and Toronto Psoriatic Arthritis Screen (ToPAS)–based on rheumatologist assessment in patients with psoriasis.
Methods |
Consecutive unselected patients with psoriasis, initially evaluated by dermatologists for plaque psoriasis, were randomized to receive 1 of 3 questionnaires. Patients were subsequently evaluated by rheumatologists to establish/exclude clinical PsA diagnosis. Using clinical PsA diagnosis as the standard for comparison, questionnaire accuracy was assessed by calculating sensitivity/specificity and positive/negative predictive values.
Results |
Of 949 patients with psoriasis evaluated by rheumatologists, 285 (30%) received a clinical diagnosis of PsA (95% confidence interval 27%-33%). Probable PsA was detected in 45.1%, 43.0%, and 42.9% of patients using PASQ, PEST, and ToPAS, respectively. Sensitivity ranged from 0.67 to 0.84; specificity, 0.64 to 0.75; positive predictive value, 0.43 to 0.60; and negative predictive value, 0.83 to 0.91.
Limitations |
Not all patients completed all questionnaires; lack of standardized diagnostic criteria introduced possible bias.
Conclusion |
PASQ, PEST, and ToPAS are useful screening tools that can help dermatologists identify patients without PsA and patients with possible PsA who may benefit from rheumatologist assessment.
Le texte complet de cet article est disponible en PDF.Key words : assessment, dermatologist, diagnosis, psoriasis, psoriatic arthritis, rheumatologist prevalence, screening
Abbreviations used : PASQ, PEST, PsA, ToPAS
Plan
| Sponsored by Pfizer Inc, which was involved in the design and conduct of the study; collection, management, analysis, and interpretation of data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. |
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| Disclosure: Dr Mease received grant support and/or honoraria for consultations or speaking engagements from Abbott, Amgen, Biogen Idec, Bristol-Myers Squibb, Celgene, Crescendo, Forest, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer Inc, and UCB. Dr Gladman received grant support from Abbott, Amgen, Bristol-Myers Squibb, Janssen, Pfizer Inc, and UCB. Dr Helliwell received honoraria for speaking engagements from Pfizer Inc. Dr Khraishi received unrestricted educational grants from Pfizer Canada. Ms Fuiman, Dr Bananis, and Dr Alvarez are employees of Pfizer Inc and owners of Pfizer Inc stock. |
Vol 71 - N° 4
P. 649-655 - octobre 2014 Retour au numéro
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