title: Evidence-based recommendations on the role of dermatologists in the diagnosis and management of psoriatic arthritis: systematic review and expert opinion.
abstract: BACKGROUND
  Psoriatic arthritis (PsA) can develop at any time during the course of psoriasis.
  
  
  OBJECTIVE
  The aims of these practical recommendations are to help dermatologists identify patients at risk of PsA, to diagnose PsA in collaboration with rheumatologists and to gain a better understanding of initial PsA management.
  
  
  METHODS
  A scientific committee consisting of 10 dermatologists and a rheumatologist selected clinically relevant questions to be addressed by evidence-based recommendations using the DELPHI method. For each question, a systematic literature review was performed in Medline, Embase and the Cochrane Library databases. The levels of evidence of all selected and reviewed articles were appraised according to the Oxford levels of evidence.
  
  
  RESULTS
  An expert board of 30 dermatologists reviewed and analysed the evidence and developed recommendations for the selected questions. Agreement among participants was assessed on a 10-point scale, and the potential impact of the recommendations on clinical practice was evaluated. Among the 6960 references identified, 190 relevant articles were included in the reviews. Three recommendations regarding risk factors for PsA and one regarding PsA prevalence were issued. The mean agreement score between participants varied from 7.8 to 9.6. Three recommendations on PsA screening tools that can be used by dermatologists were issued. The mean agreement score between participants varied from 7.7 to 9.4. Initial PsA treatment options according to published guidelines were critically appraised for axial and peripheral involvement and enthesitis/dactylitis. Three recommendations were issued. The mean agreement score between participants varied from 7.6 to 8.7.
  
  
  CONCLUSIONS
  The systematic literature research and meta-analyses did not provide high-quality evidence to support recommendations regarding PsA screening. Conversely, PsA treatment options were supported by strong evidence.
  
  
  CONCLUSIONS
  Cooperation between dermatologists and rheumatologists should be emphasized to better identify and manage PsA patients.
authors.affiliation: Aix-Marseille University, UMR 911, INSERM CRO2, Assistance Publique and Dermatology Department, Timone Hospital, Marseille, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Richard
authors.forename: T
authors.initials: T
authors.lastname: Barnetche
authors.forename: M
authors.initials: M
authors.lastname: Rouzaud
authors.forename: M
authors.initials: M
authors.lastname: Sevrain
authors.forename: A P
authors.initials: AP
authors.lastname: Villani
authors.forename: S
authors.initials: S
authors.lastname: Aractingi
authors.forename: F
authors.initials: F
authors.lastname: Aubin
authors.forename: M
authors.initials: M
authors.lastname: Beylot-Barry
authors.forename: P
authors.initials: P
authors.lastname: Joly
authors.forename: D
authors.initials: D
authors.lastname: Jullien
authors.forename: M
authors.initials: M
authors.lastname: Le Maître
authors.forename: L
authors.initials: L
authors.lastname: Misery
authors.forename: J-P
authors.initials: JP
authors.lastname: Ortonne
authors.forename: A
authors.initials: A
authors.lastname: Cantagrel
authors.forename: C
authors.initials: C
authors.lastname: Paul
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D003880:Dermatology; D019317:Evidence-Based Medicine; D006801:Humans; D010819:Physician's Role; D017410:Practice Guidelines as Topic; D012307:Risk Factors