New Care Model Improves Early PsA Diagnosis in Psoriasis Patients

wrist joint painDue to a higher rate of undiagnosed psoriatic arthritis (PsA) in psoriasis patients, a new care model suggests that musculoskeletal (MSK) ultrasounds, triage questionnaires, and clinical assessments by an advanced practice physiotherapist should be utilized to help identify patients with PsA with MSK symptoms. These findings were presented at the 2017 ACR/ARHP Annual Meeting.

 

Often, poor patient outcomes are reported among patients with psoriasis due to delays in diagnosis. In an effort to create a novel model of care that involved a self-referral system and central triage clinic for psoriasis patients with MSK symptoms to compare the efficacy of several triage methods for PsA, researchers invited patients with psoriasis to contact the research team if they were experiencing MSK symptoms.  

The participants who joined were assessed in a central triage clinic to determine the likelihood of PsA. The researchers used a multi-step triage process to determine diagnoses that included:

  • three PsA screening questionnaires (TOPAS-2, PEST, PASE); 
  • MSK ultrasound assessment of symptomatic joints and entheses; 
  • clinical assessment by an advanced practice physiotherapist; and, 
  • levels of c-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

The performance of each triage method to identify PsA was assessed by calculating its sensitivity, specificity, positive predictive value, negative predictive value and area under the receiver operating characteristic curve. Additionally, following triage, patients were seen by a rheumatologist who was unaware of the triage results. 

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