Background/Purpose: Psoriatic Arthritis (PsA) remains an under–diagnosed disease among patients with psoriasis (PsO). Dermatologists are not routinely trained to detect musculoskeletal manifestations hence arthritis, enthesitis and spondylitis may be frequently missed at dermatology settings. The Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire is a patient reported outcome that may help dermatologists identify patients who may need a rheumatology referral. PASE is composed of 15 questions (2 subscales on symptoms and function), is reliable, generates a continuous score (15-75) higher in patients with PsA and is sensitive-to-change with disease severity and treatment. Purpose – to validate a Brazilian Portuguese version of the PASE (PASE-P)

Methods: PASE was translated into Portuguese with a wording adaptation of subscales titles and rating scale (disagree-agree substituted with false–true) to fit the cultural response style of Brazilian patients. A multicenter study was conducted in four university dermatology clinics, from January to March 2011. In each center, consecutive patients with a confirmed diagnosis of PsO responded to the PASE-P and were subsequently evaluated by a rheumatologist blind to the questionnaire. Based on clinical history and physical examination, patients were classified as: PsO only, PsO + osteoarthritis (OA) and/or chronic myofascial pain (CMP) syndrome, PsA (CASPAR criteria) ± OA and/or CMP.  Laboratory tests and x-Ray imaging were performed as clinically indicated by the rheumatologist. PASE-P was retested in a sub-sample after a mean time of 20 days (12-30)

Results: 465 PsO patients completed the study. Mean age was 48.8±15.7 yrs, 50% were females and PsO mean duration was 15.5±11.8yrs. The PASE-P distinguished participants with PsA (158) from non-PsA (307), with mean scores of 37.8 ±17.2 vs 22.7±11.5 (p<0.001), ROC AUC of 0.777 (95%CI: 0.732-0.823); the best cut point was 25, giving 0.728 sensitivity (SE) and 0.735 specificity (SP). Patients with PsA not on any systemic treatment (42) had higher scores (mean 47.5±14.1) and the best cutoff from non-PsA was 38, SE 0.786, SP 0.876 (AUC 0.908, 95%CI 0.868-0.948).  A subanalysis of PsA vs OA (66), showed scores of 37.8 vs 24.4±14.3 (p<0.001) and a cutoff of 22, 0.785 SE, 0.697 SP. (AUC 0.881, 95%CI 0.818-0.945). The internal consistency for PASE-P was high (Cronbach´s alfa 0.928) and the test-retest ICC was 0.974.

Conclusion: PASE-P is a newly translated tool that is reliable, sensitive and specific to screen for PsA in a population of Brazilian portuguese-speaking PsO patients seen in dermatology clinics

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cross-cultural-adaptation-validation-and-reliability-of-the-brazilian-version-of-the-psoriatic-arthritis-screening-evaluation-tool/