Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose
Psoriatic Arthritis (PsA) is a progressive inflammatory joint disease that can lead to severe joint damage. New treatment strategies can be very effective in early stages of the disease. This requires early recognition of the symptoms to be PsA. Several screening tools have been developed to enhance early recognition. However, most were developed in secondary care, while early recognition should ideally take place in primary care.
Our objective was to evaluate the screening performance of the PEST, PASE and EARP to identify psoriatic arthritis among primary care psoriasis patients with recurrent spells musculoskeletal complaints (MSC).
Methods
We conducted a cross-sectional study in adult primary care patients with psoriasis who reported recurrent spells MSC. Patients were selected by ICPC code S91 for psoriasis and the presence of recurrent spells of MSC (joints, enthesis or low back pain) was determined by telephone interview. Patients completed the PEST, PASE & EARP questionnaires before clinical evaluation by a trained research nurse. Assessments included PASI, LEI/MASES, 66/68-joint count and the presence of nail-psoriasis. If clinical evaluation suggested the presence of arthritis or axial disease, or ultrasound (US) evaluation showed Power Doppler signal in an enthesis, patients were referred to the rheumatologist.
A PsA case was defined by fulfilling the CASPAR criteria. Sensitivity and specificity were determined for the PEST and EARP cut off ≥3 and PASE cut off ≥44 as well as ≥47.
Results
480 psoriasis patients participated with a mean±SD age of 55.9±13.9 years and 50.8% being male (Table 1). We found 54 new cases of PsA (10.2%). Among the cases the skin was slightly more affected and more tender joints were reported, while nails were affected evenly compared to the non-cases. The PEST had a true positive rate of 63.0% and a false positive rate of 30.0%, for the EARP this was 87.0% and 67.1%. The PASE had a true positive rate of 62.9% and a false positive rate of 45.6% at the cut off of ≥44 and 55.6% and 36.4% at the cut off of≥47 (Table 2).
Conclusion
Modest sensitivity was observed for the PEST and PASE with an acceptable false positive rate for the PEST, while the EARP had high true and false positive rate, which is undesirable for screening. The performance of all screening tools was lower than previously reported in secondary care settings.
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Table 1 Characteristics of the study population (n=480) |
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Non-Cases (n=426) |
Cases (n=54) |
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Age mean (SD) |
56.0 (14.0) |
55.2 (12.4) |
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% Men |
50.5 |
53.7 |
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TJC median (IQR) |
0 (0-3) |
2.5 (0-7)* |
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SJC median (IQR) |
– |
0 (0-2) |
|
PASI median (IQR) |
2.2 (0.9-4) |
3.1 (1.6-4.4)* |
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Nail abnormalities n (%) |
64 (15.2) |
8 (14.8) |
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EARP median (IQR) |
3 (2-5) |
5 (3-6)* |
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PEST median (IQR) |
2 (1-3) |
3 (2-4)* |
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PASE median (IQR) |
41 (33-49) |
48 (40-52)* |
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TJC=Tender Joint Count, SJC=Swollen Joint Count, PASI=Psoriasis Area Severity Index *p<0.05 |
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Table 2 Sensitivity & Specificity of Screening Tools for PsA among primary care psoriasis patients |
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Cut off |
Sensitivity (95% CI) |
Specificity (95% CI) |
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PEST |
≥3 |
63.0 (48.7-75.7) |
70.0 (65.4-74.3) |
|
EARP |
≥3 |
87.0 (75.1-94.6) |
32.9 (28.4-37.5) |
|
PASE |
≥44 |
63.0 (48.7-75.7) |
54.5 (49.6-59.3) |
|
|
≥47 |
55.6 (41.4-69.1) |
63.6 (58.8-68.2) |
Disclosure:
M. C. Karreman,
None;
A. E. A. M. Weel,
None;
M. van der Ven,
None;
M. Vis,
None;
I. Tchetverikov,
None;
M. Wakkee,
None;
T. E. C. Nijsten,
None;
J. M. W. Hazes,
None;
J. J. Luime,
Pfizer bv,
2.
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