title: Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening.
abstract: BACKGROUND
  National Institute for Health and Care Excellence (NICE) guidelines recommend annual screening for psoriatic arthritis (PsA) in all patients with psoriasis. Currently, no validated assessment tools have been recommended for screening for juvenile PsA (JPsA).
  
  
  OBJECTIVE
  To determine dermatologists' practice when assessing children's joints and explore the challenges dermatologists experience when looking for joint disease, in order to inform future strategies to improve early detection of arthritis.
  
  
  METHODS
  Structured telephone interviews were undertaken with dermatologists identified through the British Society of Paediatric Dermatology. Percentages for binary and categorized responses were calculated. Thematic content analysis was used to generate a set of core themes across the interview data.
  
  
  RESULTS
  Of the 41 consultant dermatologists contacted, 23 agreed to be interviewed. Of these, 78% (18/23) reported they routinely ask about joint disease. Only 13% (3/23) routinely examine the joints of children with psoriasis. Overall, assessment for JPsA lacked a structured, evidence-based approach. The average confidence rating for assessing joint disease was low (score of 3). The two key barriers described for detecting arthritis were a lack of experience and training, and subtle or difficult to detect signs. The two main suggestions for improving detection were the introduction of an assessment tool/guideline and increased clinical experience and training.
  
  
  CONCLUSIONS
  There is a clear need for dermatologists to use a standardized approach for screening and to increase their confidence in paediatric musculoskeletal examination. In this article, we provide guidance on screening for psoriatic arthritis in children based on our clinical experience.
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.|Paediatric Dermatology Department, Nottingham Children's Hospital, Nottingham, UK.
authors.forename: E
authors.initials: E
authors.lastname: Burden-Teh
authors.affiliation: Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK.
authors.forename: K S
authors.initials: KS
authors.lastname: Thomas
authors.affiliation: Paediatric and Adolescent Rheumatology Department, Nottingham Children's Hospital, Nottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Rangaraj
authors.affiliation: Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
authors.forename: J
authors.initials: J
authors.lastname: Cranwell
authors.affiliation: Paediatric Dermatology Department, Nottingham Children's Hospital, Nottingham, UK.
authors.forename: R
authors.initials: R
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D015535:Arthritis, Psoriatic / Q000175:diagnosis*; D002648:Child; D002983:Clinical Competence; D000072085:Dermatologists; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010818:Practice Patterns, Physicians'; D006113:United Kingdom