Arthritis Screening Questionnaire Research Articles

E017 An early inflammatory arthritis questionnaire to enable enhanced triage and a scoping exercise to assess clinical utility

Abstract Background/Aims The quality of early inflammatory arthritis (EIA) referrals from primary care can vary even with a standardised referral form leading to large numbers of non-EIA patients being seen. Poor utilisation of EIA slots places pressure on an EIA service’s ability to see suspected EIA patients within 3 weeks of referral. To overcome this challenge, a questionnaire was devised to enable enhanced EIA triage and a scoping exercise was carried out to assess clinical utility. Methods 50 patients attending the EIA clinic completed the questionnaire (Table 1) either self-administered or via telephone prior to their appointment. Early Inflammatory Arthritis Screening Questionnaire (Table 1) Positive answers were scored 1 with a maximum score of 11. Following their appointment, the patient diagnosis was collected from patient records. Results Of the 50 patients, 14 (28%) had a confirmed EIA diagnosis and the other 36 (72%) patients had a range of alternative diagnoses. In the confirmed EIA group, the scores ranged from 5-8/11 with an average mean score of 7.0 and median of 7. Further analysis showed patients with a score over 5/11 including symptom duration of 12 months and under (Q1) identified all the confirmed EIA patients. Applying the above criteria to our 50 study patients resulted in 27/50 patients qualifying for an EIA appointment slot and 14/27 (52%) would have been confirmed with EIA. After applying these cut off criteria the sensitivity of the questionnaire was 100% and the specificity was 64%. The non-EIA group scores ranged from 0 - 8/11 with an average mean score of 4.9 and median score of 5. Conclusion In our service triage of EIA referrals on a standardised form resulted in poor utilisation of EIA slots. Triage using the questionnaire improved the EIA slot allocation and increased EIA conversion rate from 28% to 50%. This questionnaire appears to be a promising tool to improve utilisation of EIA appointments. Telephone assessment could be delivered by any member of the multidisciplinary team. Disclosure J. Burton: None. R. Sathananthan: None. S. Levy: None. N. Horwood: None. T. Ahmed: None. R. Suresh: None.

A cross-sectional questionnaire survey involving physicians for the clarification of the diagnosis and current status of therapeutic intervention of psoriatic arthritis in Japan.

Patients with psoriatic arthritis (PsA) often experience comorbid, irreversible joint destruction, therefore early diagnosis and treatment of PsA are important. The diagnosis requires a comprehensive assessment, which includes an interview, a physical examination, a visual examination of the skin and nails, a blood test, and an imaging test. To clarify how patients with PsA are actually diagnosed and how physicians collaborate among clinical departments, we conducted a web-based questionnaire survey of 500 physicians (dermatologists, rheumatologists, and orthopedists) frequently involved in PsA treatment in Japan. The survey showed that those patients are rarely confirmed to have axial arthritis, peripheral arthritis, enthesitis, or dactylitis by general dermatology practitioners (GP dermatologists). Overall, <60% of patients suspected of having PsA underwent PsA examination by GP dermatologists more than once every 6 months; this percentage is lower than that of patients who underwent PsA examination by rheumatologists and orthopedists. The Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire is the most commonly used for PsA screening. However, users of PASE were only 11.0%, 25.3%, 14.8%, and 24.1% of GP dermatologists, attending dermatologists in hospitals (HP dermatologists), rheumatologists, and orthopedists, respectively. While >80% of HP dermatologists, rheumatologists, and orthopedists used imaging tests (ultrasound, X-ray, and magnetic resonance imaging) for PsA screening, only 40% of GP dermatologists performed imaging tests. Regarding the demands on the healthcare environment of PsA treatment, early diagnosis and treatment for PsA are crucial in every clinical department. The present study showed that GP dermatologists rarely perform imaging tests or confirm a PsA diagnosis, thus patients may miss out on appropriate treatment through collaboration among clinical departments and step-up therapy. Because patients with PsA present diverse comorbid clinical symptoms, early diagnosis, including routine imaging tests, and appropriate treatment in collaboration with other experts are necessary.

Reliability and validity of the Persian version of psoriatic arthritis screening questionnaire.

The Early Arthritis for Psoriatic Patients (EARP) questionnaire is a fast and simple way to screen psoriatic arthritis. This study was carried out to investigate the diagnostic accuracy of the Persian version of the Early Arthritis for Psoriatic Patients (P-EARP) questionnaire. A total of 100 psoriasis patients responded to the questionnaire after the translation procedure (translation, back translation). After determining the validity of the questionnaire, the diagnostic accuracy of the P-EARP questionnaire was assessed using the ROC curve (receiver operating characteristic curve). Internal and external reliability of the questionnaire were also evaluated by statistical tests. In assessing the reliability of the questionnaire using test-retest, correlation coefficient (r=0.994, p <0.001) and Cronbach's alpha (α = 0.85) were obtained. The P-EARP questionnaire had a sensitivity and specificity of 90.48% and 96.55% in ROC analysis, respectively, and cutoff point 3 was regarded as the cutoff point of the P-EARP questionnaire like the original version of the questionnaire (EARP). The results of this study showed that the P-EARP questionnaire had high sensitivity and specificity for the identification of psoriatic arthritis. The P-EARP questionnaire is an appropriate screening tool for the identification of psoriatic arthritis in the dermatology clinics.

Comparative Efficacy of Different Triage Methods for Psoriatic Arthritis: Results From a Prospective Study in a Rapid Access Clinic.

We undertook this study to identify the optimal combination of triage methods to identify psoriatic arthritis (PsA) among psoriasis patients with musculoskeletal symptoms in a rapid access clinic and to describe their outcome after 1 year. Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their musculoskeletal symptoms. Each patient was assessed by the following 3 triage modalities: 1) assessment by an advanced practice physical therapist; 2) targeted musculoskeletal ultrasound (MSK-US); and 3) PsA screening questionnaires. The patients were then evaluated by a rheumatologist who determined the patient's disease status and classified them into the following groups: not PsA, possibly PsA, or PsA. Patients returned for a 1-year follow-up visit and were reassessed for change in their disease status. Sensitivity and specificity were calculated for each individual modality, as well as for combinations of modalities. A total of 203 patients with psoriasis and musculoskeletal symptoms were enrolled. The percentage of patients classified as having PsA was 8.8%, and 23.6% were converted into the possibly PsA group. There was no significant difference in the individual performance of the modalities. The highest sensitivity was seen with MSK-US (89%), and the highest specificity was found with the Psoriatic Arthritis Screening and Evaluation questionnaire (79%). The addition of MSK-US data improved the performance of the modalities. A total of 9 patients were classified into the PsA group after 1 year. All patient-reported outcome measures had significantly improved at 1 year (P < 0.001). Combining MSK-US with a screening questionnaire for PsA improved the triage of patients with suspected PsA.

Assessment of four screening tools and retrieval of key questions to detect undiagnosed psoriatic arthritis in Chinese patients with psoriasis: A multicenter study.

Several screening tools have been developed to facilitate early diagnosis of psoriatic arthritis (PsA); however, their performance varied greatly across different studies. In this study, we validated and compared the performance of four screening tools in detecting undiagnosed PsA Chinese patients with psoriasis, and determined the key questions and their weights. The four screening tools were the Early Arthritis for Psoriatic Patients (EARP) questionnaire, Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire, Psoriasis and Arthritis Screening Questionnaire (PASQ), and Psoriasis Epidemiology Screening Tool (PEST). The receiver-operator curve (ROC) with area under curve (AUC) was used to determine sensitivity, specificity, and accuracy. Least absolute shrinkage and selection operator and logistic regression were utilized to retrieve key questions, and a nomogram was utilized to visualize their weights. Of 482 psoriasis patients from dermatology clinics, 77 were newly diagnosed with PsA. Another 68 patients with newly diagnosed PsA from rheumatology clinics were incorporated in the analysis. ROC analysis indicated that the optimal cut-off values for EARP, PASE, PASQ, and PEST were 3, 40, 7, and 3, with corresponding sensitivities of 91.4%, 88.6%, 86.2%, and 88.5%, and specificities of 88.6%, 75.2%, 80.2%, and 83.6%, respectively. The AUC of EARP (0.925) was higher than those of PASE (0.885), PASQ (0.905), and PEST (0.827). However, none of them were sufficiently sensitive to identify pure axial PsA (sensitivities of EARP, PASQ, and PASE were 25.0%, 36.8%, and 42.1%, respectively). Twelve key questions were retrieved from these four tools to establish a nomogram with a high discrimination (C-index=0.993) and a good calibration (mean absolute error=0.014). In conclusion, to screen undiagnosed PsA, EARP has slightly better balanced sensitivity and specificity, and higher accuracy. The retrieval of key questions and nomogram signify the necessity of attributing different scores to differently weighted questions when developing a new screening tool to make it function more efficiently.

Validation of the Simple Psoriatic Arthritis Screening (SiPAS) questionnaire in a Turkish psoriatic population.

Screening of psoriatic arthritis (PsA) in patients with psoriasis (PsO) is critical for the prevention of irreversible joint erosions, deformity, and disability. The SiPAS questionnaire is a short, simple and useful tool designed to screen PsA. This study aimed to evaluate validity of the SiPAS questionnaire in Turkish patients with PsO. The Turkish translation of SiPAS was sent to us by the developer authors of the original index. Subjects were recruited from dermatology outpatient clinics. All patients' demographic parameters and SiPAS questionnaire results were recorded. After patients completed the questionnaire they were assessed by a rheumatologist according to standard protocol which included a complete history, detailed physical examination, laboratory tests and Classification for Psoriatic Arthritis (CASPAR) criteria. Receiver operating characteristics (ROC) were assessed to obtain sensitivity and specificity of the Turkish version of the SiPAS questionnaire. One hundred and thirty subjects were recruited into the study. The mean age of subjects were 43.5years and the 55.4% of subjects were female. Of these, after rheumatologic evaluation 42 patients were diagnosed as PsA. The area under the ROC curve was 0.994 which means as excellent predictor and optimum cut-off threshold to discriminate patients diagnosed with PsA was 3 according to this ROC curve analysis. The overall sensitivity and specificity based on cut-off threshold of 3, were 97.6% and 94.3%, respectively. The Turkish version of the SiPAS questionnaire is a simple useful, time-saving and valid tool for screening PsA in patients diagnosed with PsO with its high sensitivity and specificity. A SiPAS score ≥3 is an indication for referral to a rheumatologist.

Assessment of enthesitis in patients with psoriasis: Relationships with clinical features, screening questionnaries results, and quality of life: An ultrasound study

Background/Aim. Often asymptomatic, enthesitis can be an integral feature of the wide clinical spectrum in psoriasis as well as an early sign of development of psoriatic arthritis (PsA). It may be difficult to clinically recognize enthesitis in patients with psoriasis or distinguish it from other causes of extraarticular pain. Ultrasound (US) expanding use with the development of accurate assessments through standardized US algorithms as the Glasgow Ultrasound Enthesis Scoring System (GUESS) and the Madrid Sonographic Enthesitis Index Scoring System (MASEI) scores made the US the dominant imaging technique in diagnosing enthesitis. The aims of this study were to establish the prevalence of US signs of en-thesitis, compare it with screening questionnaires results, and estimate possible connections of US verified enthesitis with quality of life (QOL) of patients with psoriasis without PsA diagnosis. Methods. A cross-sectional study was performed on 67 patients with psoriasis who were without systemic therapy. The clinical presence of enthesitis was examined by an experienced rheumatologist, and systemic inflammation was estimated through serum level of C-reactive protein (CRP). The Psoriasis Area Severity Index (PASI) and Body Surface Area- Psoriasis (BSA-PsO) were calculated by a dermatologist. Visual analogue scale (VAS) for pain, screening questionnaires ? the Toronto Psoriatic Arthritis Screening (ToPAS), Psoriasis Ep-idemiology Screening Tool (PEST), Psoriatic Arthritis Screening and Evaluation (PASE), Early Psoriatic Arthritis Screening Questionnaire (EARP), and Psoriasis and Arthrosis Screening Questionnaire (PASQ) ? were filled by patients. GUESS and MASEI scores were determined by US. The QOL was estimated by the Dermatology Life Quality Index (DLQI). Results. The presence of clinical enthesitis was recorded in 8.7% of patients. According to US signs of enthesitis using GUESS and MASEI scores, only 7% and 2% of patients, respectively, had no sign of enthesitis. Duration of psoriasis and age of subjects were in a significant correlation with GUESS and MASEI scores, while systemic inflammation, V AS v alue, PASI, and BSA-PsO scores were not. GUESS and MASEI scores significantly correlated with scores of all screening questionnaires as well as with DLQI. Conclusion. US can detect subclinical enthesitis better than clinical examination and widely used screening questionnaires, even though the correlations between MASEI and/or GUESS scores and results of screening questionnaires were positive. US examination is important in the multidisciplinary approach in diagnosing and managing psoriasis.

Content validity of psoriatic arthritis screening questionnaires: systematic review

Psoriatic arthritis (PsA) is the main entity associated with psoriasis (PsO). Consequently, several PsA screening instruments have been developed, most of them are self-administered questionnaires, known as patient-reported outcome measures (PROMs). To identify, summarize, and systematically evaluate the evidence of the content validity of PsA screening PROMs, in patients with PsO, by the dermatologist, based on COSMIN methodology. A structured literature search was performed, until June 2019, that included development and/or validation studies of a questionnaire for the screening of PsA in patients with PsO. The evaluation was based on the PROMs' development, relevance, comprehensiveness, and comprehensibility. Eleven PROMs were included in the systematic review with four additional validation studies of the included instruments. Only ToPAS2 (Toronto Psoriatic Arthritis Screen) questionnaire had an adequate content validity. CONTEST (Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis), CEPPA (Center of Excellence for Psoriasis sand Psoriatic Arthritis), and SiPAS (Simple Psoriatic Arthritis Screening questionnaire) qualified as inadequate. Despite the existence of eleven validated PsA screening PROMs, none were supported by very high-quality evidence of their content validity, which brings the opportunity for the creation of a new proposal PROM for the screening of PsA.

Incidence Of Psoriatic Arthritis Among Psoriatic Patients In Damietta Governorate

Background: Psoriasis is a chronic inflammatory skin disease affecting approximately 1-6% of population in the world.Aim of the work: To screen psoriatic patients for psoriatic arthritis [PsA] to improve optimal PsA management and outcome.Patients and Methods: This study included one hundred and tow patients with psoriasis recruited from the dermatology outpatient clinics in Damietta, [Al-Azhar University Hospital, Dermatology and Leprosy Hospital and El-Maasarah Hospital]. Patients should fulfill a Simple Psoriatic Arthritis Screening Questionnaire [SiPAS] to calculate the prevalence of psoriatic arthritis among psoriatic patients in Damietta.Results: The study included 42 [41.2%] females and 60 [58.8%] males with age range between 6 -88 years old with mean age 45 years old. Among the 102 included patients with psoriasis, 36 patients [35.3%] had score [≥3]; [63.9%] of them were men and [36.1%] were women with mean age 51 years old, mean age of onset of psoriasis 31 years old and mean duration of psoriasis 19.14 . [77.8%] of them had psoriatic nail lesions. On the other side, 66 patients [64.7%] had score [<3] with mean age 45.19 years old, mean age of onset of psoriasis 32 and mean duration of psoriasis 9 years.Conclusion: Early diagnosis of PsA could prevent permanent joint damage or spinal fusion and could improve long-term patient outcome. The SiPAS questionnaire can be a powerful tool to help dermatologists to quickly screen PsA during their clinical practice. The SiPAS questionnaire is able to quickly screen psoriasis patients for PsA. A SiPAS score ≥3 is an indication for referral to a rheumatologist.

Usefulness of the Psoriatic Arthritis Screening and Evaluation Questionnaire to Monitor Disease Activity in Management of Patients with Psoriasis: Findings from the EPI-PSODE Study.

BackgroundPsoriasis and psoriatic arthritis (PsA) are included in the group of immune-mediated inflammatory diseases (IMIDs) caused by systemic inflammation; however, indicators for monitoring inflammatory activity in patients with psoriasis, such as the Psoriasis Area and Severity Index (PASI), are limited.ObjectiveTo determine whether the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire can be used to monitor disease activity in patients with psoriasis.MethodsThis was a multicenter, noninterventional, cross-sectional study. Demographic factors and PASI and PASE scores were collected to investigate associations between each.ResultsPASE data were available for 1,255 patients, of whom 498 (39.7%) had a score of ≥37. Compared with the group with PASE score <37, the group with score ≥37 had a higher proportion of women (34.9% vs. 48.8%, p<0.0001), older mean age at diagnosis (36.4 vs. 41.7 years, p<0.0001), more severe disease activity using PASI and body surface area measures (p=0.0021 and p=0.0008, respectively), and higher mean body mass index (23.7 vs. 24.1, p=0.0411). In a multiple linear regression model, PASE score was positively associated with cutaneous disease activity (p<0.0001).ConclusionAfter risk-adjustment, PASE was positively associated with PASI, which suggests that PASE can be sensitive to disease activity. Since psoriasis is regarded as one of the IMIDs, PASE may be utilized as a tool not only to screen PsA but also to monitor disease activity.

Psoriatic arthritis screening: a systematic review and meta-analysis.

To systematically review the accuracy and characteristics of different questionnaire-based PsA screening tools. A systematic review of MEDLINE, Excerpta Medical Database, Cochrane Central Register of Controlled Trials and Web of Science was conducted to identify studies that evaluated the accuracy of self-administered PsA screening tools for patients with psoriasis. A bivariate meta-analysis was used to pool screening tool-specific accuracy estimates (sensitivity and specificity). Heterogeneity of the diagnostic odds ratio was evaluated through meta-regression. All full-text records were assessed for risk of bias with the QUADAS 2 tool. A total of 2280 references were identified and 130 records were assessed for full-text review, of which 42 were included for synthesis. Of these, 27 were included in quantitative syntheses. Of the records, 37% had an overall low risk of bias. Fourteen different screening tools and 104 separate accuracy estimates were identified. Pooled sensitivity and specificity estimates were calculated for the Psoriatic Arthritis Screening and Evaluation (cut-off = 44), Psoriatic Arthritis Screening and Evaluation (47), Toronto Psoriatic Arthritis Screening (8), Psoriasis Epidemiology Screening Tool (3) and Early Psoriatic Arthritis Screening Questionnaire (3). The Early Psoriatic Arthritis Screening Questionnaire reported the highest sensitivity and specificity (0.85 each). The I2 for the diagnostic odds ratios varied between 76 and 90.1%. Meta-regressions were conducted, in which the age, risk of bias for patient selection and the screening tool accounted for some of the observed heterogeneity. Questionnaire-based tools have moderate accuracy to identify PsA among psoriasis patients. The Early Psoriatic Arthritis Screening Questionnaire appears to have slightly better accuracy compared with the Toronto Psoriatic Arthritis Screening, Psoriasis Epidemiology Screening Tool and Psoriatic Arthritis Screening and Evaluation. An economic evaluation could model the uncertainty and estimate the cost-effectiveness of PsA screening programs that use different tools.

Semantic and psychometric validation of the Brazilian Portuguese version (PASE-P) of the Psoriatic Arthritis Screening and Evaluation questionnaire.

PASE (Psoriatic Arthritis Screening and Evaluation) was developed in the English language to screen for inflammatory arthritis among patients with psoriasis. It is 15 item self administered questionnaire with a score from 15 to 75. A higher score indicates a greater risk for inflammatory joint disease. The purpose of this study was to translate, adapt and validate this questionnaire into Brazilian Portuguese (PASE-P). METHODS: 465 patients diagnosed with psoriasis (158 with psoriatic arthritis confirmed by a rheumatologist according to the CASPAR criteria and 307 without) were evaluated in dermatology clinics. We performed the analysis of semantic equivalence in eight steps. For psychometric equivalence, we evaluated the data quality, reliability, construct validity, well-known groups and discriminant characteristics of the items, as well as a ROC curve to determine optimal PASE-P cutoff points in case identification and their sensitivity / specificity. The final version presented excellent reproducibility (CCI = 0.97) and reliability (Cronbach’s alpha> 0.9). A cut-off point of 25 distinguished between patients with and without psoriatic arthritis, with sensitivity of 69.5 and specificity of 86.8. PASE-P proved to be culturally valid and reliable to screen for psoriatic arthritis in Brazilian patients with psoriasis.

PP36 Early Diagnosis And Treatment Of Psoriatic Arthritis

Introduction:Screening for psoriatic arthritis (PsA) is expected to identify patients at earlier stages of the disease. Early treatment is expected to slow disease progression and delay the need for biologic therapy. This study estimated the cost-effectiveness of screening tools for PsA in Canada.Methods:A Markov model was built to estimate the associated costs and quality-adjusted life-years (QALYs) of screening tools for PsA in patients using topical treatment for psoriasis. The screening tools included: the Toronto Psoriatic Arthritis Screening (ToPAS) questionnaire; the Psoriasis Epidemiology Screening Tool (PEST); the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire; and the Early ARthritis for Psoriatic patients (EARP) questionnaire. Health states were defined by disability levels, as measured by the Health Assessment Questionnaire (HAQ), and state transition was modeled according to annual disease progression. Screening was assumed to be effective during a 2-year sojourn period. Incremental cost-effectiveness ratios (ICERs) were estimated based on health-state specific costs and utilities. A probabilistic analysis was undertaken to account for parameter uncertainty. All results were compared with the commonly cited cost-effectiveness threshold of CAD 50,000 (USD 37, 600) per additional QALY.Results:Screening with the ToPAS questionnaire resulted in cost savings compared with no screening or the EARP questionnaire, with a total cost of CAD 30,706 (USD 23,090) and 17.29 QALYs. The PEST dominated the PASE questionnaire and was more costly and more effective than the ToPAS questionnaire, with an ICER of CAD 312,398 (USD 234,909). The results were most sensitive to test sensitivity and specificity, HAQ progression, and average HAQ score at diagnosis and the start of biologic therapy. A scenario analysis tested screening efficacy for a 1-year period before diagnosis, with the ToPAS questionnaire remaining the most cost-effective option.Conclusions:Screening was cost-effective compared with no screening at the commonly used cost-effectiveness threshold of CAD 50,000 (USD 37, 600). Value of information analyses will be useful for determining the need to collect further information around test accuracy parameters.

Translation and validation of the Spanish version of the ToPAS (Toronto Psoriatic Arthritis Screening) questionnaire for use on patients with psoriatic arthritis in Dermatology clinics in Colombia

Abstract Introduction Psoriatic arthritis screening tools are useful for the rheumatologist in optimizing referrals to the dermatology clinic. The Toronto Psoriatic Arthritis Screening Questionnaire (ToPAS) is a tool that has been developed and validated in Canada. Objectives To translate, and perform some validation tests on TOPAS for use in dermatology clinics in Colombia. Methods Translation and validation of scales. Results ToPAS was translated using standardized methodology. A pilot test was conducted on 20 patients diagnosed with psoriasis and psoriatic arthritis using the final version of the document translated into Spanish, in order to evaluate items of aspects such as understanding, ambiguity, and response time. The tool was then used on 108 patients, including 65 (60.2%) males, with 36 (33.3%) cases with a diagnosis of psoriatic arthritis, and 72 (64.7%) with psoriasis only. Using a cut-off score >8 points, it showed a sensitivity of 75% and specificity 92%, positive predictive value 82% and negative predictive value of 88%. To assess the reliability test–retest, 25 participants were selected and Pearson correlation coefficient was calculated to evaluate the correlation between the first and second application of ToPAS, which gave a value of p = 0.94, which represents a high level of correlation between the first and second application. Conclusions A translation, validation and evaluation of operational characteristics of the ToPAS questionnaire was conducted, being a practical tool for use in the dermatology clinic.

Traducción y validación de la versión en español del cuestionario ToPAS (Toronto Psoriatic Arthritis Screening Questionnaire), para el tamizaje de pacientes con artritis psoriásica en la consulta dermatológica en Colombia

IntroductionPsoriatic arthritis screening tools are useful for the rheumatologist in optimising referrals to the dermatology clinic. The Toronto Psoriatic Arthritis Screening Questionnaire (ToPAS) is a tool that has been developed and validated in Canada. ObjectivesTo translate, and perform some validation tests on TOPAS for use in dermatology clinics in Colombia. MethodsTranslation and validation of scales. ResultsToPAS was translated using standardised methodology. A pilot test was conducted on 20 patients diagnosed with psoriasis and psoriatic arthritis using the final version of the document translated into Spanish, in order to evaluate items of aspects such as understanding, ambiguity, and response time. The tool was then used on 108 patients, including 65 (60.2%) males, with 36 (33.3%) cases with a diagnosis of psoriatic arthritis, and 72 (64.7%) with psoriasis only. Using a cut-off score>8 points, it showed a sensitivity of 75% and specificity 92%, positive predictive value 82% and negative predictive value of 88%. To assess the reliability test re-test, 25 participants were selected and Pearson correlation coefficient was calculated to evaluate the correlation between the first and second application of ToPAS, which gave a value of P=.94, which represents a high level of correlation between the first and second application. ConclusionsA translation, validation and evaluation of operational characteristics of the ToPAS questionnaire was conducted, being a practical tool for use in the dermatology clinic.

Determining the Validity and Reliability of Persian Version of the Psoriatic Arthritis Screening and Evaluation Questionnaire

Background: The psoriatic arthritis screening and evaluation (PASE) questionnaire was designed in English language with no particular action for the Persian language population. The current study aimed to determine the validity and reliability of this questionnaire for screening the patients with psoriatic arthritis (PSA). Patients and methods: The PASE questionnaire was administered to 100 patients with psoriasis. After determining the validity of questionnaire, the receiver operation characteristic (Roc) curve was used to optimize the sensitivity and specificity of the questionnaire to diagnose the patients. The reliability of the PASE questionnaire was determined by a group of patients with PSA; data were analysed using SPSS. Results: Out of 100 participants, 36 had PSA. The mean ± standard deviation (SD) score of the questionnaire in the groups with PSA and without PSA were 50.19 ± 12.97 and 38.75 ± 12.53, respectively and the difference between the groups was significant (P<0.0001); the total score of the questionnaire ranged 15-75. In this questionnaire, scores higher than 42 are considered as patients with PSA, with 73.81% Sensitivity and 74.13% specificity. Correlation between the tests was significant using test-retest reliability (P<0.05; r ≥ 0.8). Conclusion: The results showed that the questionnaire has a relatively high sensitivity and specificity for distinguishing PSA patients. Furthermore the questionnaire had acceptable reliability; however, Persian version is not an adequate method for diagnosis patients with psoriatic arthritis in the absence of clinical diagnosis rheumatologist. In other words the Persian version of the PASE questionnaire is only an initial screening test for PSA diagnosis and cannot substitute for clinical examinations by a rheumatologist.

PASE and EARP questionnaires for the identification of enthesitis, synovitis, and tenosynovitis in patients with psoriasis.

The aim of this study was to assess the diagnostic value of the Psoriatic Arthritis Screening Evaluation (PASE) and Early Psoriatic Arthritis Screening Questionnaire (EARP) questionnaires in the ultrasonographic detection of enthesitis, synovitis, and tenosynovitis. A cross-sectional study was done in a total of 96 consecutive patients. Double blind clinical examination and echographic assessment were performed. A receiver-operating characteristic (ROC) model analysis for the questionnaires was established using echographic findings as reference variable. The optimal diagnostic point was determined following a Youden analysis model from the obtained data, calculating sensitivity and specificity along with predictive values, likelihood ratio, and diagnostic odds ratio. A logistic regression analysis was used to determine possible predictor variables of enthesitis, synovitis, and tenosynovitis. When enthesitis, synovitis, and tenosynovitis were considered as one outcome for the diagnostic study of the PASE or EARP questionnaire, there were no statistically significant differences among the score of the study groups and the rest of patients. The PASE and EARP tests had a diagnostic performance for enthesitis, synovitis, and tenosynovitis that followed the expected pattern when the prevalence of findings is low. In these cases, the tests increase their negative predictive value, being particularly interesting in ruling out the disease.

Frequency of undiagnosed psoriatic arthritis among psoriasis patients in Australian dermatology practice.

Psoriatic arthritis commonly develops in psoriasis patients and, if undiagnosed, can lead to potentially avoidable joint damage and an increased risk of comorbidity and mortality. Increased awareness of PsA symptoms among dermatologists provides an opportunity for earlier diagnosis, more timely therapy and prevention of disability. To provide Australian epidemiological data on the frequency of undiagnosed PsA among psoriasis patients in dermatology practice, and to investigate the impact of psoriasis on quality of life and work productivity. Nine tertiary centre dermatology practices enrolled patients presenting with plaque psoriasis and no prior rheumatologist-confirmed PsA diagnosis. Patients were screened using the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire and were referred to a rheumatologist for assessment of PsA status using CASPAR criteria if they had a PASE score ≥44. Based on the composite and sequential application of PASE and CASPAR criteria, undiagnosed PsA among psoriasis patients in this study is 9% [95% CI: 6, 12]. The PPV of PASE in this setting is 26% [95% CI: 19, 34]. Nail involvement and chronic large plaque psoriasis were identified as independent positive predictors of PsA, whereas scalp psoriasis was an independent negative predictor of PsA. Patients with moderate-to-severe psoriasis (PASI ≥15) had lower quality of life scores than patients with less severe psoriasis. In this study, the frequency of undiagnosed PsA in Australian dermatology practice was 9% among plaque psoriasis patients with no prior PsA diagnosis. Compared with psoriasis alone, the impact of undiagnosed PsA on health-related quality of life of psoriasis patients is substantial.

Alcohol Intake and Risk of Incident Psoriatic Arthritis in Women

Alcohol intake has been associated with an increased risk of psoriasis. However, the association between alcohol intake and risk of psoriatic arthritis (PsA) has been unclear. We evaluated the association between alcohol intake and risk of incident PsA in a large cohort of US women. Our present study included a total of 82,672 US women who provided repeated data on alcohol intake over the followup period (1991-2005). Self-reported PsA was validated using the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire. Cox proportional hazards models were used to estimate the age-adjusted and multivariate-adjusted HR and 95% CI for the PsA in association with alcohol intake. We documented 141 incident PsA cases during 14 years (1,137,763 person-yrs) of followup. Compared to non-drinkers, the multivariate HR for PsA were 0.70 (95% CI 0.48-1.01) for 0.1-14.9 g/day, 1.43 (95% CI 0.67-3.08) for 15.0-29.9 g/day, and 4.45 (95% CI 2.07-9.59) for ≥ 30.0 g/day of cumulative average alcohol intake. Risk estimates were generally consistent when using updated alcohol intake and baseline alcohol intake in 1991 as the exposures, and when the analysis was restricted to those who developed psoriasis during the followup. Excessive alcohol intake was associated with an increased risk of incident PsA in a cohort of US women.

Screening for Psoriatic Arthritis in Korean Psoriasis Patients Using the Psoriatic Arthritis Screening Evaluation Questionnaire.

BackgroundPsoriatic arthritis (PsA) is chronic seronegative inflammatory arthritis that causes irreversible joint damage. Early recognition of PsA in patients with psoriasis is important for preventing physical disability and deformity. However, diagnosing PsA in a busy dermatology outpatient clinic can be difficult.ObjectiveThis study aimed to validate the Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire for the detection of PsA in Korean patients with psoriasis.MethodsThe PASE questionnaire was prospectively given to 148 patients diagnosed with psoriasis but without a previous diagnosis of PsA. All patients underwent radiologic and laboratory examinations, and a subsequent clinical evaluation by a rheumatologist.ResultsEighteen psoriasis patients (12.2%) were diagnosed with PsA according to the Classification Criteria for Psoriatic Arthritis. The PASE questionnaire scores of differed significantly between PsA and non-PsA patients. Receiver operator characteristic analysis showed an area under the curve of 0.82 (95% confidence interval: 0.72, 0.92) for PASE score. A PASE score cut-off of 37 points had a sensitivity of 77.8% and specificity of 82.3% for the diagnosis of PsA.ConclusionThe PASE questionnaire is a simple and convenient screening tool for detecting PsA in Korean dermatology clinics. A PASE questionnaire score of 37 points appears to be an appropriate cut-off for screening Korean psoriasis patients.