title: Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: Systematic review and meta-analysis.
abstract: BACKGROUND
  Skin psoriasis precedes the onset of psoriatic arthritis (PsA) in 84% of patients with psoriasis. Dermatologists have an important role to screen psoriasis patients for PsA. The efficiency of PsA screening remains unknown.
  
  
  OBJECTIVE
  We sought to determine the point prevalence of undiagnosed PsA in patients with psoriasis using a systematic search of the literature and meta-analysis.
  
  
  METHODS
  PubMed, Cochrane, and Embase database searches yielded 394 studies for review. No study aimed to determine the prevalence of undiagnosed PsA in patients with psoriasis. We assumed that the prevalence of newly diagnosed PsA in patients with psoriasis at the time they seek medical care could be a sound estimate of this value. Seven epidemiological studies and 5 studies on PsA screening questionnaires allowed us to clearly identify patients with newly diagnosed PsA and were selected for review.
  
  
  RESULTS
  The prevalence of undiagnosed PsA was 15.5% when all studies were considered and 10.1% when only epidemiological studies were considered.
  
  
  CONCLUSIONS
  Data were obtained from studies not designed to address the question at hand. Heterogeneity was high (I(2) = 96.86%), and therefore a random effects model was used.
  
  
  CONCLUSIONS
  The high prevalence of undiagnosed PsA in patients with psoriasis adds to the recommendation that dermatologists need to screen all patients with psoriasis for PsA.
authors.affiliation: Department of Dermatology at Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France. Electronic address: axel.villani@chu-lyon.fr.
authors.forename: Axel Patrice
authors.initials: AP
authors.lastname: Villani
authors.affiliation: Department of Dermatology, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Rouzaud
authors.affiliation: Department of Dermatology, Hôpital Morvan, Université de Bretagne, Brest, France.
authors.forename: Morgane
authors.initials: M
authors.lastname: Sevrain
authors.affiliation: Méthodomics, Mortagne-sur-Sèvre, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Barnetche
authors.affiliation: Department of Dermatology, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France.
authors.forename: Carle
authors.initials: C
authors.lastname: Paul
authors.affiliation: Department of Dermatology, Hôpital de la Timone, Université de la Méditerranée Aix Marseille II, Marseille, France.
authors.forename: Marie-Aleth
authors.initials: MA
authors.lastname: Richard
authors.affiliation: Department of Dermatology, Hôpital Haut-Lévêque, Université de Bordeaux, Bordeaux, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Beylot-Barry
authors.affiliation: Department of Dermatology, Hôpital Morvan, Université de Bretagne, Brest, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Misery
authors.affiliation: Department of Dermatology, Hôpital Charles-Nicolle, Université de Rouen, Rouen, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Joly
authors.affiliation: private practice, Caen, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Le Maitre
authors.affiliation: Department of Dermatology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Université René Descartes, Paris, France.
authors.forename: Selim
authors.initials: S
authors.lastname: Aractingi
authors.affiliation: Department of Dermatology, Hôpital Saint-Jacques, Université de Franche-Comté, Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Aubin
authors.affiliation: Department of Rheumatology, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, Toulouse, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.affiliation: Department of Dermatology, Hôpital Archet, Centre Hospitalier Universitaire de Nice, Nice, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Ortonne
authors.affiliation: Department of Dermatology at Hôpital Edouard Herriot, Université Claude Bernard Lyon 1, Lyon, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Jullien
mesh_terms: D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000453:epidemiology*; D015897:Comorbidity; D057210:Delayed Diagnosis; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D020380:Needs Assessment; D015995:Prevalence; D011565:Psoriasis / Q000453:epidemiology*; D018570:Risk Assessment
keywords: cutaneous psoriasis; dermatologists; early detection; prevalence; psoriatic arthritis; systematic review