Background/Purpose:

Several self-administered screening questionnaires are available to identify patients suspected as suffering from psoriatic arthritis (PsA) among patients with psoriasis, thus facilitating their referral to a rheumatologist. Two questionnaires, the Toronto Psoriatic Arthritis Screen (ToPAS) and the Psoriatic Arthritis Screening and Evaluation tool (PASE), were found to have high sensitivity and specificity among Canadian and American psoriasis patients. The aim of our study was to validate and compare the Hebrew versions of PASE and ToPAS questionnaires among Israeli psoriasis patients.

Methods:

A cross-sectional study included 99 patients with psoriasis attending dermatology clinics and 15 patients from a combined rheumatology-dermatology clinic who completed the PASE and ToPAS questionnaires. Psoriasis patients who had PASE scores of ≥44 and ToPAS scores of >8 were considered to be suspected PsA cases. Specialized rheumatologists, blind to the questionnaires’ results, evaluated all participants for symptoms and signs of PsA. Patients with inflammatory arthritis underwent laboratory and radiology work-ups. A definitive diagnosis of PsA was made by a rheumatologist applying the CASPAR criteria. The questionnaires’ performance was assessed using the receiver operating curve (ROC) analysis and the magnitudes of sensitivity and specificity.

Results:

The questionnaires were completed by 114 patients with psoriasis, of which 38 (33.3%) met the CASPAR criteria for PsA (group A) and 76 (66.7%) did not (group B). The two groups were comparable with regard to age, gender, duration of psoriasis, family history of psoriasis, ethnicity and education. A statistically significant difference was noted between the average scores of patients with PsA and those with psoriasis but without arthritis (Mean (95% Confidence Interval)): PASE symptoms (24.2 (21.67-26.76), 12.3 (11.01-13.52) P<0.0001, respectively), PASE functional (26.02 (23.28-28.77), 11.75 (10.42-13.08) P<0.0001, respectively), PASE total (50.24 (43.32-55.15), 24.04 (21.63-26.45) P<0.0001, respectively) and ToPAS (8.26 (7.58-8.95), 4.4 (3.92-4.9) P<0.0001, respectively). The sensitivity and specificity of the PASE questionnaire were 71.1% and 89.5%, respectively, and those of the ToPAS questionnaire were 52.6% and 93.4%, respectively. The area under the ROC curve (AUC) was 0.9093 and 0.8901 for the PASE and ToPAS questionnaires, respectively. The difference between the AUC's (0.0192) was not significant (P=0.59).

Conclusion:

The ToPAS and PASE questionnaires identified PsA patients with moderate to high sensitivity and specificity among Israeli patients with psoriasis. No statistically significant difference in the performance of the two questionnaires appeared, although the PASE questionnaire had higher sensitivity. Administering the questionnaires may facilitate early detection, referral and treatment of psoriatic arthritis patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-and-validation-of-screening-questionnaires-for-psoriatic-arthritis-in-patients-with-psoriasis/