Background/Purpose: Due to the high prevalence of PsA among patients with PsO,¹ rheumatologists and dermatologists should recognize early signs and symptoms of joint involvement among patients with PsO without diagnosed PsA.^2,3This analysis sought to evaluate the prevalence of joint symptoms and frequency of joint exams for patients with plaque PsO without PsA in the US.

Methods: This analysis was based on US data from the Adelphi 2011 and 2013 Psoriasis Disease Specific Programme, a cross-sectional survey of 91 dermatologists and their patients with PsO. Patients with suspected or confirmed PsA were excluded from the analysis. Joint symptoms were reported separately from both patients and physicians.  Joint exams were reported by physicians and included tender joint count, swollen joint count, rheumatoid factor, immunoglobin A and immunoglobin M tests. Clinical and health-related quality of life (HRQoL) parameters were compared between 2 groups: patients with physician-reported joint symptoms without joint exams, and patients without physician-reported joint symptoms or who had a joint exam. Similar comparisons were made using patient rather than physician-reported joint symptoms. T-tests or Mann-Whitney U tests for numerical variables and chi-square tests or Fisher’s exact tests for categorical variables were applied.

Results: A total of 1,002 patients were included in the analysis (mean age 45.7±15.7 [SD], 54.8% male). Overall, only 4.3% received joint exams. Physician-reported joint symptoms were less frequent than patient-reported joint symptoms (8.5% vs. 25.4%). Among those with physician-reported and patient-reported joint symptoms, 79.0% and 90.7% of patients did not receive a joint exam, respectively. Only 6.7% of the entire sample had physician-reported symptoms but no joint exams, while 22.9% had patient-reported symptoms but no joint exams. Compared with patients without physician-reported joint symptoms or who had a joint exam, patients with physician-reported joint symptoms but no joint exams had significantly poorer EuroQoL-5D (3L) (EQ-5D) utility scores (0.83 vs. 0.91), greater activity impairment (21.4% vs. 14.9%) as measured by the Work Productivity and Activity Impairment questionnaire (WPAI), and more severe psoriasis (Body Surface Area: 14.1% vs. 9.7%) (all p<0.05).  Compared with patients who did not self-report symptoms or who had a joint exam, patients who self-reported symptoms but had no joints exams had significantly poorer EQ-5D utility scores (0.87 vs. 0.91) and greater activity impairment (19.3% vs. 14.0%) as measured by the WPAI (both p<0.05).

Conclusion: In the US, over three quarters of PsO patients without a diagnosis of PsA did not receive a joint exam when the patient or patients’ physician reported joint symptoms. Early diagnostic actions such as referral to a rheumatologist or joint exams could increase recognition of PsA, leading to earlier diagnosis and appropriate treatment.

References: 1. Gladman D et al. Expert Opin Investig Drugs 2000;9(7):1511-22.

2. Haroon M et al. Ann Rheum Dis 2013;72(5):736-40.

3. Mease P et al. J Am Acad Dermatol 2013;69(5):729-35.

« Back to 2015 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-of-joint-symptoms-and-frequency-of-joint-exams-for-patients-with-plaque-psoriasis-without-confirmed-psoriatic-arthritis-a-us-analysis/