Background/Purpose: Psoriatic arthritis (PsA) is frequently undiagnosed and/or undertreated. Given the elevated risk of disability with treatment delays, we launched a quality improvement initiative to streamline PsA screening, symptom severity/impact assessment, and specialist referral to improve patient outcomes.

Methods: Following an established clinical framework, our study integrated the Psoriasis Epidemiology Screening Tool (PEST) and the Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) into the electronic medical record across 26 dermatology clinics. Patients with psoriasis (PsO) underwent PsA screening via the PEST. Those scoring ≥3 or already diagnosed with PsA subsequently completed the PsAID-12, which served to inform management. Applying the validated Patient Acceptable Symptom State (PASS) cutoff, a PsAID-12 score ≤4 is considered an acceptable PsA symptom state and supported continuation of current treatment. Conversely, a score above 4 indicated an unacceptable PsA symptom state, warranting treatment modification or referral to rheumatology. Results were sent to providers in real-time for review.

Results: Over 20 months, 7,140 patients with PsO were encountered by dermatology providers, with 1,159 (16.2%) having a baseline diagnosis of PsA. In total, 2,551 PsO patients completed the PEST; 652 (25.6%) scored ≥3 and subsequently completed the PsAID-12. Of those who took the PsAID-12, 63.4% scored ≤4, reflecting effective symptom management. Of the 36.6% of patients not on target, 80 (24.4%) received rheumatology referrals.

Conclusion: These results underscore the feasibility of our framework in facilitating PsA detection and assessment, referring patients to rheumatology, and ultimately improving the quality of care.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/feasibility-of-a-streamlined-approach-for-psoriatic-arthritis-screening-and-symptom-assessment/