Diagnosis Of Psoriatic Arthritis Research Articles

Successful Screening of Undiagnosed Psoriatic Arthritis in Primary Care Utilising Digital Interventions Within a Quality Improvement Programme

Background: Despite the advancements in the management of psoriasis (PsO) and psoriatic arthritis (PsA), there remains a significant delay to diagnosis of PsA. National guidelines recommend regular screening of patients with PsO for PsA. The aim of this study was to increase the screening of patients with PsO, and reduce the delay to diagnosis in PsA. Methods: A retrospective baseline audit was conducted in patients with PsO attending a large general practice (Brookside Group Practice, Reading, UK) between November 2022–April 2023. In the follow-up stage between May–November 2023, a digital Egton Medical Information System (EMIS; Emis Health, Rawdon, Leeds, UK) web template, using the Psoriasis Epidemiology Screening Tool (PEST) questionnaire was implemented. The number of patients with PsO screened for PsA, and the number of newly diagnosed PsA cases, were recorded. Results: At baseline, 15 patients with PsO were identified, and none had PsA screening done. In the follow-up phase, 28 patients coded for PsO were identified. There was an increase in the number of patients screened for PsO from 15 to 28, representing an increase of 87% from baseline. From the follow-up group, 12 (43%) patients were screened for PsA. These patients were referred to the specialist clinic, and seven (58%) had confirmed PsA. This represented a population of patients with previously undiagnosed PsA within the general practitioner (GP) surgery. Conclusions: The authors have successfully implemented an integrated and interactive digital screening tool for PsA within the GP system. This has led to an increase in the detection of patients with PsA. This practical and effective approach is in line with national guidelines for early detection, to prevent long-term damage and disability from PsA.

E002 The Psoriasis Epidemiology Screening Tool (PEST) as a mechanism for diagnosing psoriatic arthritis in dermatology practice: 5 year follow-up data from a quality improvement project

Abstract Background/Aims We carried out a QIP in 2018 as a collaboration between dermatology and rheumatology. 280 patients with psoriasis attending outpatient appointments in dermatology completed Psoriasis Epidemiology Screening Tool (PEST) forms between January and April 2018; results were recorded on the patient record. 110 patients (39%) had a positive PEST score, indicating a possible diagnosis of PsA. Of these, 48/110 were not already known to rheumatology services. Patients with a positive PEST were informed of the results and their GP was advised to refer to rheumatology if they had not previously been assessed. The pathway aimed to avoid duplication of assessments, and acknowledged that patients with psoriasis may have had a rheumatology assessment at another hospital, or even be under their ongoing care. Methods We reviewed the hospital electronic and regional patient records of the 48 patients in January 2023 in order to identify which of these had been referred for a rheumatology review and/or had a new diagnosis of psoriatic arthritis. Results One patient was excluded due to lack of access to local records. Of the remaining 47 patients, 31 had a PEST score of 3, 15 patients scored 4, and 1 patient scored 5. 5/47 (10%) patients were referred for a rheumatology opinion following a positive PEST score. 3/5 of these patients went on to be diagnosed with psoriatic arthritis. 7/47 (15%) patients had a diagnosis of psoriatic arthritis on GP records with no secondary care input. None of these patients were on treatment for PsA. 7/31 patients with PEST score of 3 were diagnosed with PsA, 2/15 patients with PEST score of 4 and the only patient with a score of 5 were diagnosed with PsA. Overall 10/47 (21%) patients were diagnosed with PsA. Conclusion A letter from dermatology to request review of joint disease and consideration of a rheumatology referral in response to a positive PEST score appears to have resulted in a low response in terms of rheumatology review. Others seemingly acquired a diagnosis of PsA without rheumatology review, potentially through the PEST score alone, which is concerning, and not how the PEST score should be used. Screening for PsA in psoriasis populations remains problematic. PEST score is recommended by dermatology guidelines, but lacks specificity and can result in high numbers of referrals, with potential duplication of work if referred repeatedly. It is important to recognise PsA in patients with psoriasis, but equally important that this is done efficiently and accurately, so patients are not inadvertently treated or inaccurately labelled with this diagnosis. Rheumatologists should work with dermatology and primary care colleagues to improve understanding of PsA and the PEST questionnaire, and consider the optimum pathways to ensure that PsA is recognised and treated promptly. Disclosure S. Ahmed: None. M. Babiker: None. M. Osama: None. M. Ahmed: None. K. Jobling: None. P. Hampton: None. B. Thompson: None.

HLA alleles heterogeneity in a sample of colombian patients with a diagnosis of psoriatic arthritis

The objective is to describe the HLA allelic frequency in PsA and correlate it with demographic and clinical variables. Retrospective study of adult patients with a diagnosis of PsA (n=23) and healthy controls (n=46), all with a request for HLA-A, B, C, DR. Typing was performed using HLA-PCR/SSO LifeCodes and analyzed on the LUMINEX IS100/200 xMAP® system. (Ethics/Code HMC2022-014). One hundred thirty-eight alleles were included from 69 individuals, 43,5% women, aged 44,5±16,5 years in patients with PsA, with a mean age of disease onset of 33.4±14 years. Only 9.5% had a high Body Mass Index and dyslipidemia was the most frequent comorbidity (34.8%), followed by high blood pressure (26,1%). 82% debuted with skin manifestation and once the joint disease was established, the predominance was peripheral (74%) due to arthritis/arthralgia in 74%, enthesitis in 30% and dactylitis in 13%. The allele frequencies were for HLA*A 2402 (13%), 3201 (13%) and 2427 (8,7%), for HLA*B 1402 (17,4%), 4002 (17,4%), 3801 (13%) and HLA*DR 0404 (17,4%), 0407 (13%). No HLA*B27 was identified and HLA*C0602 was only 2,2%. HLA A*0201 and DR*1301 were less frequent in controls versus PsA (p=0.024 and 0,029, respectively), while HLA*B1302 was frequent in PsA (p=0,035). Curiously, there were no positive results for HLAB*27, which may be related to the population mix. HLA Cw6 is traditionally associated with psoriasis. However, its absence has been linked to nail disorders and PsA; consequently, in our study, it had a low frequency (2,2%). On the other hand, HLA*B1302 has been related to the disease and its early onset; in the healthy Colombian population, it has been described in 0,92%; in our group, it is found to be significant in patients without establishing a clinical association. Few previous studies report HLA results in PsA in Colombia.

Risk of developing psoriatic arthritis in psoriasis cohorts with arthralgia: exploring the subclinical psoriatic arthritis stage

ObjectiveSubjects with subclinical psoriatic arthritis (PsA), defined as the presence of arthralgia in psoriasis (PsO), are at higher risk of PsA but scant real-world data exist. Our aims were to...

Assessment of Epidemiology and Clinical Profile of Psoriatic Arthritis Patients in India.

Psoriasis is an inflammatory skin disease associated with significant comorbidity. However, the characteristics of patients with psoriasis are not well documented in India, and a more detailed understanding is needed to delineate the epidemiologic profile at the regional level for better management of psoriasis. Herein, we reported the clinical profile and demographic pattern of psoriasis to further understand its burden in the Indian setting. We conducted a retrospective observational study of patients diagnosed with psoriasis who fulfilled the classification criteria for psoriatic arthritis (CASPAR) criteria. Patients were included from the rheumatology outpatient department of Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute in Mumbai, India. The outcomes included demographic and clinical profiles, patterns of joint involvement, and comorbidities associated with psoriasis. A p-value of <0.05 was considered significant. We enrolled 60 patients, with a mean age of 50.87 years and a higher proportion of females (62%). The majority of patients with less than five joints had associated comorbidities (40 out of 60). Psoriatic arthritis (PsA) occurred in 41 patients [mean ± standard deviation (SD) age of onset-38.88 ± 13.24 years], with the highest occurrence in the 30-50 years (53.3%). The majority of patients with PsA developed it within 2 to ≥5 years of psoriasis occurrence. We did not find any significant correlation between the occurrence of PsA and comorbidities, as well as the duration of PsA and the number of joints (p = 0.152). Pitting and enthesitis were the most common morphological changes noted in almost half of the patients. Our study provides an overview of the epidemiologic and clinical characteristics of psoriasis patients in India. These findings could be useful for early diagnosis of PsA and help clinicians in assessing the progression of psoriasis into PsA.

From Psoriasis to Psoriatic Arthritis: Ultrasound Insights Connecting Psoriasis with Subclinical Musculoskeletal Inflammation and the Path to Psoriatic Arthritis.

This review summarizes the literature about the transition from psoriasis to psoriatic arthritis (PsA), focusing on musculoskeletal ultrasound (MSUS) for detecting subclinical inflammation and its role in diagnosis and triage of high-risk patients. MSUS effectively detects subclinical musculoskeletal inflammation in patients with psoriasis; however, some of these lesions are non-specific and can be found in healthy individuals. Preliminary evidence suggest that subclinical sonographic findings may predict progression to PsA in psoriasis patients. MSUS can also improve referrals' accuracy and its integration in the PsA classification criteria may improve early PsA detection. MSUS is a valuable tool for detecting subclinical abnormalities in psoriasis patients, which indicate an increased likelihood of progressing to PsA. Its integration into referral protocols and clinical use could improve PsA diagnosis. We propose an MSUS-inclusive algorithm for PsA referrals and triage, which requires validation. The potential of early intervention in reducing PsA progression in psoriasis patients with subclinical inflammation remains to be established.

Window of opportunity in psoriatic arthritis: the earlier the better?

ObjectivesTo investigate whether there is a window of opportunity for psoriatic arthritis (PsA) patients and to assess which patient characteristics are associated with a longer diagnostic delay.MethodsAll newly diagnosed, disease-modifying...

Arthralgia in psoriasis vulgaris - sometimes it's worth taking a second look

The 71-year-old patient reported long-standing inflammatory arthralgia due to psoriasis vulgaris. Therapy with methotrexate led to elevated liver values; the symptoms persisted under treatment with the TNFα inhibitor adalimumab. Using arthrosonography and MRI, a predominantly periarticular inflammatory pattern on the wrists, metacarpophalangeal joints and proximal interphalangeal joints could be objectified without post-inflammatory stigmata of psoriatic arthritis. Laboratory diagnostics revealed an elevated anti-HCV titer with a high viral load consistent with a florid hepatitis C. A predominantly extrahepatic hepatitis C with associated periarthritis was diagnosed. With combined, interferon-free antiviral therapy, arthralgia suspended completely. Hepatitis C can appear through extrahepatic manifestations in the form of periarticular inflammation. Suspicious inflammatory arthralgias in psoriasis vulgaris are not conterminous with the diagnosis of psoriatic arthritis and should be evaluated by a professional rheumatologist.

PAPRIKA: A Question Bank for Assessing Psoriatic Arthritis Risk in Individuals of Diverse Ancestries.

We aimed to create a question bank about clinical factors for predicting the diagnoses of psoriatic arthritis in patients with psoriasis of various ancestries and skin tones, which can be completed entirely by patients. Utah Psoriasis Initiative participants without a psoriatic arthritis diagnosis at enrollment were observed for diagnosis during the study period. We inferred ancestry from exome sequencing data and performed Cox proportional hazards regression to identify clinical predictors of psoriatic arthritis in different ancestry groups. Based on results and literature review, we developed a question bank for assessing psoriatic arthritis risk among patients with psoriasis in various ancestries. Patient-reported untreated psoriasis induration and history of fingernail psoriasis were associated with psoriatic arthritis in participants of European and non-European ancestry. We developed the Psoriatic Arthritis Prediction and Identification Question Bank for Diverse Ancestries (PAPRIKA) version 1.0, which included questions regarding psoriasis characteristics, arthritis symptoms, comorbidities, family history, and demographics. PAPRIKA is accessible at http://bjfenglab.org/. The clinical features (untreated psoriasis induration and history of fingernail psoriasis) that can predict psoriatic arthritis in European individuals also work for non-European individuals. PAPRIKA can be used to gather psoriatic arthritis predictive data from patients with psoriasis without provider assistance and is relevant for patients across ancestries.

High-grade synovitis associates with clinical markers and response to therapy in chronic inflammatory arthritis: post hoc analysis of a synovial biomarkers prospective cohort study.

Inflammatory arthritis (IAs), such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA), are characterized by the presence of chronic synovitis. The Krenn's synovitis score (KSS), a simple tool detectable by haematoxylin/eosin staining of synovial biopsy samples, allows the discrimination between high-grade and low-grade synovitis. The aim of this study was to identify the clinical associations of KSS and to evaluate the relationship between high-grade synovitis and treatment response in IA patients. Clinical, laboratory and ultrasound data were retrieved from RA and PsA patients recruited in the prospective MATRIX cohort study. Inclusion criteria were age≥18 years, RA or PsA diagnosis, and presence of active disease with eligibility to start/modify therapy. Patients underwent ultrasound-guided synovial biopsy of one of the most involved joints before starting/modifying treatment according to treat-to-target strategy. The samples were analysed by an expert pathologist for KSS calculation. Univariable and multivariable logistic regression analyses were performed to evaluate the relationship between KSS and baseline variables. The association between KSS and treatment response at 24 weeks of follow-up was investigated in univariable logistic regression analysis. 53 patients, 34 RA and 19 PsA, completed 24 weeks of follow-up after synovial biopsy. Patients were either treatment naïve (N=6, 11%), csDMARDs-experienced (N=46, 87%) or b/tsDMARDs-experienced (N=20, 38%). Median KSS was 6.00 (Q1-Q3 4.00-7.00) in RA and 4.00 (3.00-6.00) in PsA (p=0.040), and inflammatory infiltrates score was significantly higher in RA than in PsA patients (median 3.00 vs 2.00, p=0.021). In multivariable analysis, synovial effusion in the biopsied joint (OR 9.26, 95%CI 2.12-53.91) and erythrocyte sedimentation rate (ESR) (OR 1.04, 95%CI 1.01-1.08) associated with high KSS. High-grade synovitis significantly associated with a higher probability of achieving DAS28 remission, ACR20/50 response, and Boolean2.0 remission, independently from diagnosis. Several markers of pro-inflammatory pathways associated with the presence of high-grade synovitis, and patients with higher KSS shared a higher probability of treatment targets achievement in the follow up. The integration of a simple and feasible tool like KSS in the clinical and prognostic stratification of patients with IA might help in intercepting patients with a disease more prone to respond to available treatment paradigms.

Imaging in psoriatic arthritis: established methods and emerging techniques.

Psoriatic arthritis (PsA) is a heterogeneous, chronic, inflammatory musculoskeletal disease that can lead to peripheral and axial damage and loss of function. A clear difference between PsA and other forms of inflammatory arthritis is the different forms of bone remodeling seen in PSA which incorporates not only increased bone resorption with bone erosions, osteolysis, and loss of bone mineral density but also increased bone formation with periostitis, syndesmophytes, enthesiophytes, and ankylosis. PsA, if diagnosed late, will lead to significant structural damage, the most severe form of which is known as arthritis mutilans, and loss of physical function. Imaging plays a crucial role in diagnosing and monitoring both peripheral and axial conditions associated with PsA. Radiography is currently the main modality used to monitor structural damage in PsA though commonly used scoring systems do not include bony proliferation as a criterion. Besides, radiography is limited in determining the presence and cause of periarticular soft tissue thickening, which may arise from tendinosis, tenosynovitis, synovial proliferation, bursitis, or enthesitis. Recently, much more attention has been paid to determining the imaging characteristics of PsA, which enables more precise identification of disease and severity assessment. Newer imaging technologies also enable variations in normal bone microstructure to be distinguished from disease-related abnormality. This review discusses the current state of innovative imaging modalities in PsA, specifically concentrating on their roles in PsA diagnosis and treatment, improving the early detection of PsA, and identifying patients with skin psoriasis at risk of developing psoriatic arthritis.

The shared biomarkers and immune landscape in psoriatic arthritis and rheumatoid arthritis: Findings based on bioinformatics, machine learning and single-cell analysis.

Psoriatic arthritis (PsA) and rheumatoid arthritis (RA) are the most common types of inflammatory musculoskeletal disorders that share overlapping clinical features and complications. The aim of this study was to identify shared marker genes and mechanistic similarities between PsA and RA. We utilized datasets from the Gene Expression Omnibus (GEO) database to identify differentially expressed genes (DEGs) and perform functional enrichment analyses. To identify the marker genes, we applied two machine learning algorithms: the least absolute shrinkage and selection operator (LASSO) and the support vector machine recursive feature elimination (SVM-RFE). Subsequently, we assessed the diagnostic capacity of the identified marker genes using the receiver operating characteristic (ROC) curve and decision curve analysis (DCA). A transcription factor (TF) network was constructed using data from JASPAR, HumanTFDB, and GTRD. We then employed CIBERSORT to analyze the abundance of immune infiltrates in PsA and RA, assessing the relationship between marker genes and immune cells. Additionally, cellular subpopulations were identified by analyzing single-cell sequencing data from RA, with T cells examined for trajectory and cellular communication using Monocle and CellChat, thereby exploring their linkage to marker genes. A total of seven overlapping DEGs were identified between PsA and RA. Gene enrichment analysis revealed that these genes were associated with mitochondrial respiratory chain complex IV, Toll-like receptors, and NF-κB signaling pathways. Both machine learning algorithms identified Ribosomal Protein L22-like 1 (RPL22L1) and Lymphocyte Antigen 96 (LY96) as potential diagnostic markers for PsA and RA. These markers were validated using test sets and experimental approaches. Furthermore, GSEA analysis indicated that gap junctions may play a crucial role in the pathogenesis of both conditions. The TF network suggested a potential association between marker genes and core enrichment genes related to gap junctions. The application of CIBERSORT and single-cell RNA sequencing provided a comprehensive understanding of the role of marker genes in immune cell function. Our results indicated that RPL22L1 and LY96 are involved in T cell development and are associated with T cell communication with NK cells and monocytes. Notably, high expression of both RPL22L1 and LY96 was linked to enhanced VEGF signaling in T cells. Our study identified RPL22L1 and LY96 as key biomarkers for PsA and RA. Further investigations demonstrated that these two marker genes are closely associated with gap junction function, T cell infiltration, differentiation, and VEGF signaling. Collectively, these findings provide new insights into the diagnosis and treatment of PsA and RA.

Predictive factors of psoriatic arthritis in a diverse population with psoriasis.

We aimed to analyze the clinical characteristics of patients with psoriasis and determine the predictive factors of psoriatic arthritis (PsA). This retrospective cohort study was performed among patients with psoriasis. Demographic and clinical data were collected. Psoriasis treatment was categorized as topical agents, phototherapy, oral therapy, and biologics. Predictive factors of PsA development were determined using logistic regression analyses. We included 330 patients with psoriasis, and 83 (25%) patients developed PsA. Thirty-eight (45.8%) patients who developed PsA were Malay, 24 (28.9%) were Chinese, and 21 (25.3%) were Indian. The mean age of patients with PsA was 54.2 (±15.8) years, and the duration from diagnosis of psoriasis to diagnosis of PsA was 36 (3.5-114) months. Predictive factors for developing PsA were female sex (odds ratio [OR] = 3.33, 95% confidence interval [CI] 1.78-6.22), presence of nail involvement (OR = 5.36, 95% CI 2.50-11.51), severe psoriasis (OR = 27.41, 95% CI 7.58-99.11), and oral systemic therapy prior to PsA diagnosis (OR = 4.09, 95% CI 2.04-8.22). Patients with psoriasis who are female, have nail involvement, severe skin psoriasis, and require oral systemic therapy for psoriasis may have an increased risk of developing PsA.

Ultrasound-based detection of inflammatory changes for early diagnosis and risk model construction of psoriatic arthritis.

PsA is the most prevalent coexisting condition associated with psoriasis. Early-stage PsA patients always present unspecific and subtle clinical manifestations causing delayed diagnosis and leading to unfavourable health outcomes. The application of US enables precise identification of inflammatory changes in musculoskeletal structures. Hence, we constructed US models to aid early diagnosis of PsA. This was a cross-sectional study carried out in the Department of Dermatology at West China Hospital (October 2018-April 2021). All participants underwent thorough US examinations. Participants were classified into the under 45 group (18 ≤ age ≤ 45 years) and over 45 (age >45 years) group and then randomly grouped into derivation and test cohort (7:3). Univariable logistic regression, least absolute shrinkage and selection operator, and multivariable logistic regression visualized by nomogram were conducted in order. Receiver operating characteristic (ROC), calibration curve, decision curve analysis (DCA) and clinical impact curve analysis (CICA) were performed for model verification. A total of 1256 participants were included, with 767 participants in the under 45 group and 489 in the over 45 group. Eleven and 16 independent ultrasonic variables were finally selected to construct the under 45 and over 45 model with the area under the ROC of 0.83 (95% CI 0.78-0.87) and 0.83 (95% CI 0.78-0.88) in derivation cohort, respectively. The DCA and CICA analyses showed good clinical utility of the two models. The implementation of the US models could streamline the diagnostic process for PsA in psoriasis patients, leading to expedited evaluations while maintaining diagnostic accuracy.

Search for predictors of achieving minimal disease activity during tofacitinib therapy in patients with psoriatic arthritis

Objective: to search predictors of achieving minimal disease activity (MDA) during therapy in patients with psoriatic arthritis (PsA).Materials and methods. The study included 41 patients, predominantly men (58.9 %), with a confirmed PsA diagnosis and a disease duration of at least 6 months. In all cases, the diagnosis fulfilled the CASPAR criteria. The mean age of the patients at the time of enrolment in the study was 43.0±10.1 years, the duration of PsA was 7.7±7.1 years, the duration of psoriasis was 18.6±10.4 years, and the DAPSA index was 44.2±17.1. All patients were prescribed tofacitinib at a dose of 5 mg twice daily, followed by a possible dose increase to 10 mg twice daily. In addition to a general clinical examination and a standard rheumatological examination, the level of secreted DKK-1 protein and health-related quality of life (HRQoL, using a special PsAID-12 questionnaire) were determined. Multivariate stepwise discriminant analysis was used to search for predictors for the achievement of MDA in patients with PsA and to calculate the coefficients.Results and discussion. Based on the results obtained, a predictor for the achievement of MDA (PMDA) was developed: PMDA=-1.165 × number of inflamed entheses + DKK-1 level (pmol/l) + 3.086 × PsAID-12 “Skin lesions” scale value (if this indicator was ≤3 points, it was assigned a value of 1, if it was &gt;3 points – 0) + 2.568 × PsAID-12 “Pain” scale (if this indicator was ≤6 points, it was assigned a value of 1, if it was &gt;6 points – 0).The ROC analysis, which reflects the prognostic significance of this index, showed AUC (area under the curve) of 0.803 (95% confidence interval 0.739–0.867; p=0.02). PMDA=3.89 was chosen as the cut-off value; the sensitivity of this indicator was 91 %, the specificity – 79 %. Therefore with a PMDA ≥3.89, the probability of the patient achieving a MDA after 3 months is high; with a PMDA ˂ 3.89, it is low.Conclusion. We identified factors influencing the achievement of MDA in patients with PsA and developed a mathematical model. It allows timely assessment of the quality of treatment and its correction if necessary, thereby slowing disease progression.

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.

Mortality in patients with psoriatic arthritis in Sweden: a nationwide, population-based cohort study

ObjectivesTo compare all-cause mortality and causes of death between patients with psoriatic arthritis (PsA) and the general population in Sweden.MethodsAdults with at least one main PsA diagnosis (International Classification of...

Challenges in Diagnosing Psoriatic Arthritis in Primary Care: A Meta-Ethnographic Study.

Psoriatic arthritis (PsA) is a complex and debilitating chronic inflammatory joint disorder that is often associated with psoriasis and presents significant challenges in its early diagnosis and management. Therefore, this study aimed to investigate the diagnostic intricacies of PsA in primary care settings to shed light on the prevalence, barriers, and implications of delayed diagnosis. To achieve our research objectives, we conducted a qualitative synthesis using the meta-ethnographic method, which is a robust approach for synthesizing qualitative data. We systematically searched the PubMed, Web of Science, and Embase databases for relevant articles using predefined search terms such as "psoriatic arthritis," "diagnosis," and "primary care." The inclusion criteria were narrative articles in English that provided insights into the diagnostic challenges of PsA in primary care. Conference presentations, original articles, and duplicate articles were excluded. Our analysis revealed four key themes that elucidated the multifaceted nature of PsA diagnosis in primary care: (1) a variety of initial and non-specific symptoms, highlighting the diverse clinical presentations that can mimic other conditions; (2) the lack of experience with PsA among primary care professionals, underscoring the importance of education and training; (3) the lack of skin lesions, which can complicate diagnosis when not present; and (4) a delay in diagnosis, with potentially severe consequences for patients' health and quality of life. This study highlights the challenges inherent in the diagnosis of PsA in primary care settings. The multifaceted nature of the disease, coupled with limited experience among primary care providers, often results in delayed diagnosis and subsequent treatment initiation. Early recognition and intervention are pivotal for optimizing patient outcomes. Addressing these challenges necessitates a comprehensive approach involving heightened clinical suspicion, continuous medical education, interdisciplinary collaboration, and utilization of standardized diagnostic criteria. Collaboration between primary care physicians and specialists is crucial for enhancing the accuracy and timeliness of PsA diagnosis and ultimately improving patient well-being and quality of life.

Predicting Psoriatic Arthritis in Psoriasis Patients - A Swiss Registry Study.

Psoriatic arthritis (PsA) is a prevalent comorbidity among patients with psoriasis, heavily contributing to their burden of disease, usually diagnosed several years after the diagnosis of psoriasis. To investigate the predictability of psoriatic arthritis in patients with psoriasis and to identify important predictors. Data from the Swiss Dermatology Network on Targeted Therapies (SDNTT) involving patients treated for psoriasis were utilized. A combination of gradient-boosted decision trees and mixed models was used to classify patients based on their diagnosis of PsA or its absence. The variables with the highest predictive power were identified. Time to PsA diagnosis was visualized with the Kaplan-Meier method and the relationship between severity of psoriasis and PsA was explored through quantile regression. A diagnosis of psoriatic arthritis was registered at baseline of 407 (29.5%) treatment series. 516 patients had no registration of PsA, 257 patients had PsA at inclusion, and 91 patients were diagnosed with PsA after inclusion. The model's AUROCs was up to 73.7%, and variables with the highest discriminatory power were age, PASI, physical well-being, and severity of nail psoriasis. Among patients who developed PsA after inclusion, significantly more first treatment series were classified in the PsA-group, compared to those with no PsA registration. PASI was significantly correlated with the median burden/severity of PsA (P = .01). Distinguishing between patients with and without PsA based on clinical characteristics is feasible and even predicting future diagnoses of PsA is possible. Patients at higher risk can be identified using important predictors of PsA.

Search for predictors of psoriatic arthritis in patients with psoriasis

Background: Psoriatic arthritis is a chronic inflammatory disease of the joints, spine, and entheses that can occur in patients with psoriasis. The prevalence of psoriatic arthritis is 19.7%. In 70% of cases, psoriasis precedes the development of arthritis. It has been proven that a delay in the diagnosis of psoriatic arthritis even by 6 months is associated with a deterioration in long-term radiological and functional results, leading to disability. The problem of early diagnosis of joint damage can be solved by identifying predictors of the risk of developing psoriatic arthritis in patients with psoriasis.&#x0D; Aims: to determine possible predictors for the development of psoriatic arthritis in patients with psoriasis.&#x0D; Materials and methods: The open, uncontrolled, prospective study enrolled 250 patients. The main group consisted of 190 patients diagnosed with plaque psoriasis. The control group consisted of 60 patients with psoriatic arthritis. In order to identify associations of clinical and genetic (HLA-B27 carriage) parameters with the development of psoriatic arthritis, we compared the frequency of occurrence of these parameters in patients with psoriatic arthritis and without.&#x0D; Results: Among 190 patients with plaque psoriasis 128 (67.4%) men, 62 (32.6%) women, aged 18 to 84 years (40.3015.56), the average duration of psoriasis was 10.0911, 08 (0-57 years). Among 60 patients with psoriatic arthritis 39 (65%) men, 21 (35%) women aged 18 to 86 years (44.4314.15), the average duration of psoriasis was 20.4713.22 (2-57 years), the average duration of psoriatic arthritis was 7.979.95 (047 years). Сlinical predictors for the development of psoriatic arthritis in patients with psoriasis: nail psoriasis (OR=2.244 [95% CI: 1.245 - 4.045]), severe psoriasis (PASI20) (OR=2.148 [95% CI: 1.161 - 3.975), arterial hypertension (OR = 1.982 [95% CI: 1.031 - 3.812]), duration of psoriasis over 25 years (OR = 3.365 [95% CI: 1.676 - 6.756), р0,05&#x0D; Conclusions: The joint consideration of informative predictors will allow us to develop an original multi-parameter mathematical model for calculating the risk of developing psoriatic arthritis in patients with psoriasis.