Alexis Ogdie, MD, presented research at ACR Convergence on November 12 illustrating that among patients with psoriasis (PsO) without a diagnosis of psoriatic arthritis (PsA), more than one-third were at risk of having or developing undiagnosed PsA.

Dr Ogdie is an associate professor of medicine and of epidemiology in the Perelman School of Medicine and the University of Pennsylvania in Philadelphia, where she also serves as director of the Center for Clinical Epidemiology and Biostatistics and director of the Penn Psoriatic Arthritis and Spondyloarthritis Program.

Up to one-third of patients with PsO will develop PsA in their lifetime, yet the recent Global Psoriasis and Beyond study recently reported that 71% of patients with PsO were unaware of this risk.

The Global Psoriasis and Beyond Study was a cross-sectional, quantitative online survey conducted among adults in 20 countries in the Americas, Europe, and the Asia-Pacific region. It was designed to assess the understanding of PsO and PsA as systemic diseases among patients who self-reported a physician diagnosis of moderate PsO, defined as a body surface area (BSA) >5 to < 10% affecting sensitive and/or prominent body parts; or severe PsO, defined as affected BSA ≥10% at its worst, with or without concomitant PsA, regardless of treatment.

Patients surveyed in this research completed the Psoriasis Epidemiology Screening Tool (PEST), a 5-item questionnaire on body parts affected by PsO and musculoskeletal symptoms among patients. Those who answered positively to 3 out of 5 questions were considered to have a positive score on PEST.

“We used only the population without psoriatic arthritis. Of those—3490—38% screened positive on the PEST, indicating that they may have an increased likelihood of having psoriatic arthritis,” Dr Ogdie stated.

She explained that among PEST-positive patients without PsA diagnosis, PsO severity was categorized as moderate in 26% and severe in 13% of pts. Compared with PEST-negative a higher proportion of PEST-positive patients reported dry skin that may crack and bleed (57% vs 44%), soreness around psoriatic patches (36% vs 20%), and thick and pitted nails (16% vs 12%).

“Overall there’s not that great a difference” between PEST-positive and -negative patients in terms of body parts affected by PsO, she pointed out. “Perhaps a bit more scalp psoriasis among PEST negative patients and a little more hand psoriasis among patients who are PEST positive.”

However, when reviewing responses regarding musculoskeletal symptoms, differences between PEST-positive and PEST-negative patients are much more significant. Approximately 89% of PEST-positive patients reported swollen joints compared to 27% of PEST-negative patients; 80% PEST-positive patients reported a finger or two swollen and painful for no apparent reason, compared to just 15% of PEST-negative patients; and 72% of PEST-positive patients reported heel pain in comparison to only 22% of PEST-negative.

“Patients who were PEST-positive also had a lot more comorbidities” than PEST-negative patients, Dr Ogdie explained, with higher rates of obesity, anxiety, depression, chronic gastrointestinal conditions, and cardiovascular disease. While 29% of PEST-negative patients reported no comorbidities, only 11% of PEST-positive patients reported none.

Further, the poster specified, the impact of PsO on quality of life was also substantial in higher among PEST-positive patients, with 38% and 26% of pts reporting a very large and extremely large effect on the patient's life, compared with 22% and 5% of PEST-negative patients respectively.

“In this large subpopulation of patients with psoriasis only, 38%, a relatively large number, screened positive for PsA using PEST,” Dr Ogdie explained. “This indicates a higher probability of having PsA but not necessarily that they have PsA. It’s more that they need to be seen by a rheumatologist to confirm the diagnosis.”

With more severe PsO and a higher comorbidity burden associated with higher PEST scores, she concluded, “We need to better understand this population and the value of using PEST to screen and how to best triage these patients” to ensure they receive proper diagnosis and testing.

Ogdie A, Armstrong A, Bohannan B, et al. Poster 0189. Characteristics associated with a positive PEST screening among patients with psoriasis without a diagnosis of psoriatic arthritis: Results from the global Psoriasis and Beyond study. Presented at: American College of Rheumatology Convergence. November 12, 2022.

https://meet.acrconvergence2022.org/meetings/virtual/poster/iNT3McmjBpDJu7RZ7