Toronto Psoriatic Arthritis Screen Research Articles

Validity and reliability of the Turkish version of Psoriasis Epidemiology Screening Tool for the detection of psoriatic arthritis in patients with psoriasis.

The Psoriasis Epidemiology Screening Tool (PEST) is a simple and useful questionnaire designed to screen arthritis in patients with psoriasis. This study aims to evaluate the validity and reliability of the PEST questionnaire in Turkish patients with psoriasis. Between August 2019 and September 2019, a total of 158 adult patients with psoriasis (61 males, 68 females; mean age: 43.1±13.3 years; range, 29.8 to 56.4 years) who were not previously diagnosed with PsA were included. The testing procedure for translation and cultural adaptation was carried out according to the following steps: preparation, forward translation, reconciliation, back-translation/back-translation review, harmonization, finalization, and proofreading. Patients' demographic parameters, comorbidities, PEST, and Toronto Psoriatic Arthritis Screen (ToPAS 2) results were recorded. The patients were, then, assessed by a rheumatologist who was blinded to their PEST scores. The diagnosis of PsA was made according to the Classification criteria for Psoriatic Arthritis (CASPAR). The receiver operating characteristic (ROC) was assessed to obtain the sensitivity and specificity of the PEST questionnaire. Of the patients, 42 had PsA, while 87 did not. Each parameter of PEST showed a low-high internal consistency ranging from 0.366 to 0.781. When the Question 3 was excluded, Cronbach alpha value increased to 0.866. The Cronbach alpha value of the whole scale was 0.829. The test-retest reliability of the Turkish version of PEST was determined as 0.86 for the total score (ICC=0.866 95% CI: 0.601-0.955; p<0.0001). There was a strong positive correlation between PEST and ToPAS 2 (r=0.763; p<0.001) and a moderate positive correlation between PEST and CASPAR (r=0.455; p<0.001). A cut-off value of ≥3 yielded a sensitivity of 93% and a specificity of 89% for the diagnosis of PsA with the highest Youden's index. The PEST scale was found to have a higher sensitivity, but lower specificity in the head-to-head comparison with ToPAS 2. The Turkish version of PEST is a reliable and valid tool for screening PsA in Turkish patients with psoriasis.

Assessment of the Toronto Psoriatic Arthritis Screen 2 as a Screening Tool for Psoriasis.

Psoriasis is a chronic inflammatory disease affecting multiple organ systems and resulting in reduced quality of life for many patients. A screening tool would be useful, particularly in underserviced or research settings with limited access to dermatologists. The Toronto Psoriatic Arthritis Screen, version 2 (ToPAS 2) is a validated screening tool for psoriatic arthritis containing questions specific for psoriasis. To evaluate the performance of skin-specific questions from ToPAS 2 for the diagnosis of psoriasis. Participants aged >18 were recruited from Dermatology and Family Medicine clinics and completed the ToPAS 2 questionnaire prior to being examined by a dermatologist for psoriasis. Two scoring indexes were derived from the ToPAS 2 skin-related questions using backward selection regression models. Statistical analysis was performed using receiver operating characteristic (ROC) curves to measure their performances. Two hundred and fifty eight participants were recruited. 32 (12%) were diagnosed with psoriasis by dermatologist assessment. Index 1 includes all 5 skin-related questions from ToPAS 2, while Index 2 includes three of the five questions. Both indexes demonstrate high specificity (82% to 92%), sensitivity (69% to 84%), and excellent negative predictive value (NPV) (>95%) for a diagnosis of psoriasis. The overall discriminatory power of these models is 0.823 (Index 1) and 0.875 (Index 2). Skin-related questions from ToPAS 2 have discriminatory value in detecting psoriasis, specifically questions relating to a family history, a prior physician diagnosis of psoriasis or a rash consistent with images of plaque psoriasis. This study is a valuable step in developing a screening tool for psoriasis.

Validation of the Toronto Psoriatic Arthritis Screen II (ToPAS II) questionnaire in a Brazilian population.

The Toronto Psoriatic Arthritis Screen II (ToPAS II) was developed as a tool to screen patients with probable psoriatic arthritis. We aimed to evaluate the validation of the ToPAS II questionnaire in a Brazilian population. The Portuguese translation of the ToPAS II was sent to us by the developer authors of the original index, and adapted to Brazilian Portuguese. Subjects were recruited from dermatology, general, and rheumatology outpatient clinics. After patients completed the questionnaire, they were assessed by a rheumatologist, according to standard protocol. Receiver operating characteristics (ROC) was used to obtain the sensitivity and specificity of the Brazilian Portuguese version of the ToPAS II questionnaire. One hundred and eighty-four subjects were recruited in the study. There were 70 subjects from the psoriasis group, 44 subjects from the psoriatic arthritis (PsA) group, 40 subjects from the rheumatology (non-PsA) group, and 45 healthy controls. Twenty-four patients (34.3%) in the psoriasis group had inflammatory pain and met the CASPAR classification criteria. The area under the ROC curve was 0.96, which indicates that an excellent predictor and optimum cutoff threshold to discriminate patients diagnosed with PsA used was eight as originally chosen. The overall sensitivity and specificity based on the cutoff threshold of eight were 91.3 and 90.9%, respectively. The Portuguese Brazilian version of the ToPAS II has good sensitivity and specificity and is a useful tool to screen for PsA. Key Points • Among these psoriasis patients, almost 35% in fact had psoriatic arthritis without correct diagnosis. Keeping alert of the need to disclose screening tool's use. • The TOPAS II can facilitate the screening of patients suggestive of inflammatory joint disease (with high probability of rheumatologic diagnosis) decreasing morbidity of these patients.

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.

Validation of the Toronto Psoriatic Arthritis Screen II (TOPAS II) questionnaire in a Turkish population.

To evaluate the TOPAS II questionnaire validation in a Turkish population. The Turkish translation of ToPASII was sent to us by the developer authors of the original index. Subjects were recruited from dermatology, physical medicine and rehabilitation, and rheumatology outpatient clinics. All patients' demographic parameters and ToPAS II questionnaire results were recorded. After patients completed the questionnaire they were assessed by a rheumatologist according to a standard protocol which includes a complete history, detailed physical examination, laboratory tests and CASPAR criteria. Receiver operating characteristics (ROC) assessed to obtain sensitivity and specificity of Turkish version of ToPAS II questionnaire. One hundred and fifty subjects were recruited in the study. The mean ageof subjects was 41.07years (SD 12.59) and the 58% of subjects were female. There were 46 subjects from psoriasis group, 43 subjects from psoriatic arthritis (PsA) group, 41 subjects from physical medicine and rehabilitation group and 20 subjects from rheumatology (non-PsA) group. The area under the ROC curve was 0.99 which means as excellent predictor and optimum cut-off threshold to discriminate patients diagnosed with PsA was 8 according to this ROC curve analysis. The overall sensitivity and specificity based on cut-off threshold of 8, were 95.8 and 98%, respectively. The Turkish version of ToPAS II has high sensitivity and specificity. It is simple, not time consuming and useful tool to screen for PsA in both patients with and without psoriasis.

Validation of the Toronto Psoriatic Arthritis Screen Version 2 (ToPAS 2).

We previously developed and performed an initial validation of a screening questionnaire, the Toronto Psoriatic Arthritis Screen (ToPAS), for psoriatic arthritis (PsA). In our original analysis, we found that the index constructed appeared to discriminate well between those with a confirmed diagnosis of PsA and those without PsA in various clinical settings. However, it was suggested that ToPAS would benefit from additional refinement to the questions and the scoring system, because items pertaining to axial involvement were not included in our original index. Subsequently, a second version of ToPAS was developed, ToPAS 2, which incorporated the suggested refinements. We aimed to validate ToPAS 2 as a screening instrument for PsA. ToPAS 2 was administered to 3 "diagnostic" groups of individuals - patients with PsA, patients with psoriasis, and healthy controls, and the data collected were analyzed. It was found that the new version of ToPAS, ToPAS 2, again performed well, with the axial domain now featuring in the new scoring system. The constructed index, ToPAS2_cap, had an overall area under the receiver-operation curve of 0.910, with overall values of sensitivity and specificity, at a cutpoint of 8 (or 7), of 87.2% (92.0%) and 82.7% (77.2%), respectively. ToPAS 2 shows much promise as a screening instrument for identifying PsA both in people with psoriasis and in individuals from the general population. Its performance against other proposed screening instruments for PsA should be evaluated in other clinics and for other study designs.

Comparative performance of psoriatic arthritis screening tools in patients with psoriasis in European/North American dermatology clinics

General practitioners/dermatologists may be aware of musculoskeletal symptoms in patients with psoriasis but may have difficulty accurately detecting psoriatic arthritis (PsA). We sought to evaluate 3 PsA screening questionnaires-the Psoriasis and Arthritis Screening Questionnaire (PASQ), Psoriasis Epidemiology Screening Tool (PEST), and Toronto Psoriatic Arthritis Screen (ToPAS)-based on rheumatologist assessment in patients with psoriasis. Consecutive unselected patients with psoriasis, initially evaluated by dermatologists for plaque psoriasis, were randomized to receive 1 of 3 questionnaires. Patients were subsequently evaluated by rheumatologists to establish/exclude clinical PsA diagnosis. Using clinical PsA diagnosis as the standard for comparison, questionnaire accuracy was assessed by calculating sensitivity/specificity and positive/negative predictive values. Of 949 patients with psoriasis evaluated by rheumatologists, 285 (30%) received a clinical diagnosis of PsA (95% confidence interval 27%-33%). Probable PsA was detected in 45.1%, 43.0%, and 42.9% of patients using PASQ, PEST, and ToPAS, respectively. Sensitivity ranged from 0.67 to 0.84; specificity, 0.64 to 0.75; positive predictive value, 0.43 to 0.60; and negative predictive value, 0.83 to 0.91. Not all patients completed all questionnaires; lack of standardized diagnostic criteria introduced possible bias. PASQ, PEST, and ToPAS are useful screening tools that can help dermatologists identifypatients without PsA and patients with possible PsA who may benefit from rheumatologist assessment.

Psoriatic arthritis screening tools: study design and methodological challenges

Funding sources: No external funding. Conflicts of interest: A.A.Q. has licensed the PASE questionnaire to Merck and Pfizer, has received a grant from Amgen, and is a consultant for Jansen, Novartis and Abbott. J.F.M. is a consultant for Biogen IDEC, an investigator for Amgen and has served on an advisory board for Amgen. M.E.H. has licensed the PASE questionnaire as above, and has also acted as a consultant for UCB, Amgen, Novartis, Bristol Myers Squibb and Abbott. Dear Editor, In their study ‘Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study)’, Coates et al.1 compared three published, validated screening tools for psoriatic arthritis (PsA), the Psoriasis Epidemiology Screening project (PEST), the Toronto Psoriatic Arthritis Screen (ToPAS) and the Psoriatic Arthritis Screening and Evaluation (PASE) tools.1 2 3 4 5 We would like to address how PASE was not adequately or appropriately compared in this setting.

Screening Instruments for Psoriatic Arthritis

To the Editor: In a recent study, Walsh, et al 1 sought to compare 3 published, validated screening tools for psoriatic arthritis (PsA): the Psoriasis Epidemiology Screening project (PEST), the Toronto Psoriatic Arthritis Screen (ToPAS), and the Psoriatic Arthritis Screening and Evaluation (PASE)2,3,4,5. We would like to address how PASE may not have been appropriately compared in this setting. The PASE questionnaire, developed by our group, is the only one of these 3 tools where scores have demonstrated sensitivity to change with disease activity6. PASE has similarly been shown to correlate with response to therapy7. PASE was … Address correspondence to Dr. A.A. Qureshi, Department of Dermatology, Brigham and Women’s Hospital, 221 Longwood Avenue, Boston, MA 02115, USA; E-mail: aqureshi{at}bics.bwh.harvard.edu

Comparison of three screening tools to detect psoriatic arthritis in patients with psoriasis (CONTEST study)

Multiple questionnaires to screen for psoriatic arthritis (PsA) have been developed but the optimal screening questionnaire is unknown. To compare three PsA screening questionnaires in a head-to-head study using CASPAR (the Classification Criteria for Psoriatic Arthritis) as the gold standard. This study recruited from 10 U.K. secondary care dermatology clinics. Patients with a diagnosis of psoriasis, not previously diagnosed with PsA, were given all three questionnaires. All patients who were positive on any questionnaire were invited for a rheumatological assessment. Receiver operating characteristic (ROC) curves were used to compare the sensitivity, specificity and area under the curve of the three questionnaires according to CASPAR criteria. In total, 938 patients with psoriasis were invited to participate and 657 (70%) patients returned the questionnaires. One or more questionnaires were positive in 314 patients (48%) and 195 (62%) of these patients attended for assessment. Of these, 47 patients (24%) were diagnosed with PsA according to the CASPAR criteria. The proportion of patients with PsA increased with the number of positive questionnaires (one questionnaire, 19·1%; two, 34·0%; three, 46·8%). Sensitivities and specificities for the three questionnaires, and areas under the ROC curve were, respectively: Psoriatic Arthritis Screening Evaluation (PASE), 74·5%, 38·5%, 0·594; Psoriasis Epidemiology Screening Tool (PEST), 76·6%, 37·2%, 0·610; Toronto Psoriatic Arthritis Screen (ToPAS), 76·6%, 29·7%, 0·554. The majority of patients with a false positive response had degenerative or osteoarthritis. Although the PEST and ToPAS questionnaires performed slightly better than the PASE questionnaire at identifying PsA, there is little difference between these instruments. These screening tools identify many cases of musculoskeletal disease other than PsA.

Limitations in Screening Instruments for Psoriatic Arthritis: A Comparison of Instruments in Patients with Psoriasis

To compare the abilities of 3 validated screening instruments to predict the diagnosis of psoriatic arthritis (PsA) in patients with psoriasis. Prior to a rheumatologic evaluation, 213 participants in the Utah Psoriasis Initiative completed the Psoriasis Epidemiology Screening project (PEST), the Toronto Psoriatic Arthritis Screen (ToPAS), and the Psoriatic Arthritis Screening and Evaluation (PASE). Previously established instrument cutoff scores were used to designate positive and negative classifications. Sensitivities and specificities were determined by comparing instrument classifications to the rheumatologist's diagnosis. Phenotypic features and alternative diagnoses were compared between participants who screened positively and negatively on each instrument. Discrepancies between the rheumatologist's examination findings and responses to specific instrument questions were compared. The sensitivities of PEST, ToPAS, and PASE were 85%, 75%, and 68%, and the specificities were 45%, 55%, and 50%, respectively. The instruments were less sensitive in patients with lower disease activity, fewer PsA features, and shorter disease duration. The instruments did not consistently differentiate between PsA and other types of musculoskeletal disease. Discrepancies between examination findings and responses to instrument questions occurred more frequently with ToPAS than with PEST and PASE. Sensitivities and specificities for PEST, ToPAS, and PASE were lower than previously reported. This population included patients with PsA and other types of musculoskeletal disease and may represent those most likely to complete a screening instrument and follow through with a rheumatology referral. Further analyses may enable the development of more successful screening strategies for PsA in psoriasis patients with musculoskeletal complaints.

Development of Screening Tools to Identify Psoriatic Arthritis

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that follows an indolent and progressive course. A delay in diagnosis and treatment may lead to irreversible changes such as erosive arthritis, which lead to permanent physical disability and deformity. Administration of a well-designed screening tool can increase detection of PsA and help determine the prevalence of PsA in a given population. Several tools have been developed to help clinicians screen for PsA. Members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis recently led an effort to develop and validate three PsA screening tools: the Psoriatic Arthritis Screening and Evaluation tool, the Psoriasis Epidemiology Screening Tool, and the Toronto Psoriatic Arthritis Screen.

Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS)

Objective:To develop and validate a psoriatic arthritis (PsA) screening questionnaire: the Toronto Psoriatic Arthritis Screen (ToPAS).Methods:The ToPAS was developed through review of items seen in patients with PsA and evaluation...