PRESTO: New Tool Predicts Progression to PsA

A team of investigators sought to develop a simple risk prediction model to identify patients with psoriasis at high risk of developing psoriatic arthritis (PsA).

They analyzed data from a prospective cohort of psoriasis patients who had not developed PsA at enrollment. “Participants were assessed annually by a rheumatologist for the development of PsA. Information about their demographics, psoriasis characteristics, co-morbidities, medications, and musculoskeletal symptoms was used to develop prediction models for PsA,” they explained in their report in Arthritis & Rheumatology.

Among 635 psoriasis patients, 51 during the first year of follow-up while 71 developed PsA during the 5-year follow-up period. “The risk of developing PsA within 1 year was associated with younger age, male sex, family history of psoriasis, back stiffness, nail pitting, joint stiffness, use of biologic medications, patient global health, and pain severity (AUC 72.3),” they wrote. “The risk of developing PsA within 5 years was associated with morning stiffness, psoriatic nail lesion, psoriasis severity, fatigue, pain, and use of systemic non-biologic medication or phototherapy (AUC 74.9).”

The PRESTO tool, the authors concluded, demonstrates that progression to PsA “within clinically meaningful time frames can be predicted with reasonable accuracy for psoriasis patients using readily available clinical variables.”

Eder L, MMath KL, Chandran V, et al. Derivation of a multivariable psoriatic arthritis risk estimation tool (PRESTO): a step towards prevention. Arthritis Rheumatol. Published online August 9, 2023.

https://doi.org/10.1002/art.42661