Psoriatic arthritis screening: A systematic literature review and experts' recommendations.

Ana Urruticoechea-Arana,Jordi Gratacós,Cribado Working Group ,Cristina Fernández-Carballido,Diego Benavent,Raquel Almodovar,Estíbaliz Loza,Pablo De La Cueva,Fernando León,Isabel Belinchón

doi:10.1371/journal.pone.0248571

Abstract

To analyze the performance of psoriatic arthritis (PsA) screening tools, examine their implementation in daily practice, and reach a consensus about the best screening tool for implementation in daily practice in different medical settings. A systematic literature review (SLR), structured telephone interviews to hospitals, and a multidisciplinary nominal group meeting were all conducted. The SLR employed sensitive search strategies using Medline, Embase, and the Cochrane Library up to January 2020. Two reviewers independently selected articles that reported data on PsA screening tools and that included sufficient data to at least calculate the sensitivity and specificity of those tools (e.g., questionnaires, algorithms, specific questions, and biomarkers). The hospital interviews collected data regarding the process of suspected PsA diagnosis and referral to rheumatology, the implementation of PsA screening tools, and barriers and facilitators to implementation of those tools. In the nominal group meeting, a multidisciplinary team of experts discussed all these data and subsequently recommended a screening tool for implementation. The SLR included 41 moderate-quality studies that analyzed 14 PsA screening tools, most of which were questionnaire-based tools. All of these studies reported a moderate-good performance but presented different characteristics regarding the time to completion or the number and type of items or questions. The implementation of screening tools was low (30.5%). The experts ultimately recommended regular use of a PsA screening tool, preferably the PURE-4 questionnaire. The implementation of PsA screening tools like the PURE-4 questionnaire in daily practice likely improves the prognosis of PsA patients.

Highlights

The implementation of Psoriatic arthritis (PsA) screening tools like the PURE-4 questionnaire in daily practice likely improves the prognosis of PsA patients
Psoriatic arthritis (PsA) is a prevalent chronic inflammatory disease that is associated with joint destruction and disability [1, 2]
It must be noted that cross-cultural validations do not describe all the necessary requirements to be considered adequate, so we must be very careful with their results

Summary

Introduction

Psoriatic arthritis (PsA) is a prevalent chronic inflammatory disease that is associated with joint destruction and disability [1, 2]. Up to 30% of patients with psoriasis will develop PsA during the disease course, mostly after the onset of psoriasis and usually within 10 years of their skin disease’s first manifestations [3]. PsA is a heterogeneous and complex disease that has several patterns of joint involvement, including axial and peripheral disease, and other extra-articular manifestations like enthesitis, dactylitis, and uveitis [2]. Undiagnosed PsA is common in patients with psoriasis. Several studies and meta-analyses reveal that between 5% and 15.5% of patients with psoriasis may have undiagnosed PsA [4, 5]. Several national and international consensus documents, as well as other projects, recommend a multidisciplinary approach that includes primary care physicians, dermatologists and rheumatologists, in order to establish effective strategies for early and accurate PsA detection [7, 8]

Methods

Results

Conclusion