title: Comparative performance of psoriatic arthritis screening tools in patients with psoriasis in European/North American dermatology clinics.
abstract: BACKGROUND
  General practitioners/dermatologists may be aware of musculoskeletal symptoms in patients with psoriasis but may have difficulty accurately detecting psoriatic arthritis (PsA).
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Not all patients completed all questionnaires; lack of standardized diagnostic criteria introduced possible bias.
  
  
  CONCLUSIONS
  PASQ, PEST, and ToPAS are useful screening tools that can help dermatologists identify patients without PsA and patients with possible PsA who may benefit from rheumatologist assessment.
authors: Swedish Medical Center, Seattle, Washington; University of Washington School of Medicine, Seattle, Washington. Electronic address: pmease@philipmease.com.
authors: Philip J
authors: PJ
authors: Mease
authors: University of Toronto, Toronto, Ontario, Canada.
authors: Dafna D
authors: DD
authors: Gladman
authors: University of Leeds, Leeds, United Kingdom.
authors: Philip
authors: P
authors: Helliwell
authors: Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada.
authors: Majed M
authors: MM
authors: Khraishi
authors: Specialty Care, Pfizer Inc, Collegeville, Pennsylvania.
authors: Joanne
authors: J
authors: Fuiman
authors: Specialty Care, Pfizer Inc, Collegeville, Pennsylvania.
authors: Eustratios
authors: E
authors: Bananis
authors: Specialty Care, Pfizer Inc, Collegeville, Pennsylvania.
authors: Daniel
authors: D
authors: Alvarez
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D015535:Arthritis, Psoriatic / Q000175:diagnosis / Q000453:epidemiology*; D016001:Confidence Intervals; D003880:Dermatology / Q000379:methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011565:Psoriasis / Q000175:diagnosis / Q000453:epidemiology*; D012219:Rheumatology / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
keywords: assessment; dermatologist; diagnosis; psoriasis; psoriatic arthritis; rheumatologist prevalence; screening