Abstract
Introduction
Psoriatic arthritis (PsA) affects 10–30% of individuals with psoriasis. Early detection of PsA is crucial to prevent potential irreversible joint damage. The Psoriasis Epidemiology Screening Tool (PEST) has proven to be an effective tool in daily clinical practice, but limited data is available on the analysis of positive responses. Our study aimed to determine the combination of positive responses to individual questions and characterize patients with positive PEST results based on specific anatomical sites of psoriasis, duration of the disease, and epidemiological parameters that could potentially predict PEST positivity.
Methods
The PEST questionnaire was randomly administered to patients with psoriasis without psoriatic arthritis attending the outpatient unit for psoriasis treatment. A total of 351 patients completed the PEST questionnaire over a 24-month period. Patients undergoing various types of therapy were included. Each patient completed the PEST questionnaire once, and epidemiological data (such as age, weight, height, body mass index, smoking status, age of disease onset, disease duration, and family history of psoriasis) were collected, as well as types of therapy.
Results
We included 242 men and 109 women with an average age of 49.4 years and duration of psoriasis of 23.3 years. A positive PEST questionnaire result was found in 28.5% of patients; 13.1% had a score of 3, 8.0% a score of 4 and 7.4% a score of 5. Nail psoriasis, higher age, and therapy with biological/targeted therapy were associated with PEST positivity. The most frequently observed positive response was nail involvement.
Conclusion
The PEST questionnaire is a well-established screening tool for identifying patients at risk of having undiagnosed psoriatic arthritis in daily dermatological practice. Patients with nail involvement, higher age, or treated with modern systemic therapy should be closely monitored, as these factors indicate a higher risk of a positive PEST result and consequently higher risk of having psoriatic arthritis.
Keywords: PEST, Psoriasis, Psoriatic arthritis
Key Summary Points
| The Psoriasis Epidemiology Screening Tool (PEST) questionnaire is routinely used for the screening of psoriatic arthritis. Limited data is available on which answers are most often positive and which demographic and clinical characteristics are associated with a positive PEST. |
| This study analyzed the PEST questionnaire in daily practice to determine the combination of positive responses to individual questions and characterize patients with positive PEST results based on specific anatomical sites of psoriasis, duration of the disease, and epidemiological parameters. |
| A positive PEST questionnaire result was found in 28.5% of patients; 13.1% had a score of 3, 8.0% a score of 4, and 7.4% a score of 5. Nail psoriasis, higher age, and therapy with biological/targeted therapy were associated with PEST positivity. The most frequently observed positive response was nail involvement. |
| The PEST questionnaire is a simple screening tool to identify patients at risk of having psoriatic arthritis. Special attention should be focused on older patients with nail psoriasis who are being treated with biologic/targeted therapy. |
Introduction
Psoriasis (PsO) is as a chronic immune mediated inflammatory skin disease associated with several comorbidities. In 10–30% of patients, psoriatic arthritis (PsA) may occur [1]. Cutaneous manifestations precedes the development of PsA of up to 80% of cases. Psoriatic arthritis is defined as a spondyloarthritis with diverse clinical manifestations within the peripheral and axial musculoskeletal system. It can manifest as asymmetrical or symmetrical peripheral oligo- or polyarthritis, enthesitis, dactylitis, or spinal involvement [2–4].
PsA may occur within 10 years or even later after the diagnosis of psoriasis [5, 6]. Early detection is crucial because a delay of 6 months in diagnosing of PsA may lead to irreversible joint changes [7–9]. Unfortunately PsA still remains undiagnosed in many patients with PsO. Several studies have reported between 10.1% and 15.5% of undiagnosed cases [10].
Different screening questionnaires are available such as CONTEST and PEST questionnaire [11]. Psoriasis Epidemiology Screening Tool (PEST) has proven to be effective in screening of PsA. The sensitivity of the questionnaire varies from 60% to 94%, while specificity ranges between 66% and 78% [12]. The questionnaire consists of five questions focused on nail involvement, swelling of fingers and joints, heel pain, and arthritis history. Each positive response is scored 1 point. PEST score equal to or greater than 3 indicates a risk of PsA [13]. Limited data is available in the literature to help to identify which patients have a higher risk of having positive PEST [14, 15]. Most of the patients with psoriasis are followed by dermatologists which makes it crucial to have a simple and sensitive tool for screening of PsA such as the PEST questionnaire and provide with the maximum guidance on how to use it effectively.
The aim of this study was to analyze clinical characteristics such as specific localization of psoriasis (scalp, nails, genital area) and demographics between patients with positive and negative PEST and to identify which questions were most frequently positive in patients with a minimum PEST score of 3.
Methods
Data Source and Study Population
In this observational study, the PEST questionnaire was completed by 351 adult patients with psoriasis in a single academic center for psoriasis treatment. Patients were enrolled from routine clinical practice, presenting for clinical examination within the time frame of January 2020 to December 2021. The PEST questionnaire was distributed randomly to patients who had their first examination in the center, but also to patients who were coming for regular follow-up, irrespective of ongoing treatments (topical, conventional, or targeted) with no diagnosed PsA. Each patient was provided with a printed PEST questionnaire, comprising five questions, for manual completion without investigator intervention. The study was conducted in accordance with the Helsinki Declaration of 1964 and all subsequent amendments, and all patients provided informed consent. The study was approved by the ethical committee of the University Hospital Kralovske Vinohrady.
Study Outcomes
Demographic and epidemiological data were collected, including patients’ gender, weight and height, BSA (body surface area), family history of psoriasis, age of PsO onset, disease duration, and smoking status. Psoriasis Area and Severity Index (PASI) score and the involvement of anatomically specific areas (scalp, nails, intertriginous regions) were also analyzed. Treatment history included topical and systemics conventional and targeted.
Data Analysis
The entire statistical analysis was performed using R software. Descriptive statistics were used to categorize patients on the basis of individual characteristics (all epidemiological and demographic data), providing the total count and percentage of patients for each variable. Mean values and standard deviations were used for continuous variables. Statistical tests like the chi-square test and Wilcoxon rank sum test were used to compare different variables and groups. Within the logistic regression analysis, the influence of various factors on PEST test positivity/negativity was examined. In the model, only statistically significant variables were assessed and retained, with statistical significance defined as p < 0.05.
Results
Demographics and Clinical Characteristics
A total of 351 patients with psoriasis were included in the study, comprising 242 men (68.9%) and 109 women (31.1%). The individual demographic and epidemiological characteristics of all participants are summarized in Table 1. The mean age was 49.4 (SD 14.0) years old and the average age of onset of the disease was 26 (SD 14.8) years. The average duration of PsO was 23.3 (SD 13.9) years. According to body mass index (BMI), 155 patients (44.2%) were overweight and 119 (33.9%) were obese. Only 76 patients (21.7%) had normal weight. Positive family history of psoriasis was present in 137 (39%) of patients. Nearly half of the patients were non-smokers (45%), with 62 (17.7%) being previous smokers and 131 (37.3%) were active smokers. The average PASI on the positive PEST questionnaires was 5.2 (SD 6.3) and 5.3 (SD 7.6) on the negative. When patients were questioned about the presence of psoriasis in specific anatomical locations, the scalp was the most commonly affected area (77.5%). Nail changes were observed by half of the responders (50.7%), followed by involvement of intertriginous regions (19.7%). Average PASI score on the day of completing the questionnaire was 5.3 (SD 7.2).
Table 1.
Demographics, clinical and treatment characteristics
| All patients | Positive (PEST ≥ 3) | Negative (PEST < 3) | |
|---|---|---|---|
| Number of patients | 351 (100%) | 100 (28.5%) | 251 (71.5%) |
| Men | 242 (68.9%) | 63 (63%) | 179 (71.3%) |
| Age (years) | 49.4 (± 14.0) | 52.3 (± 11.6) | 48.2 (± 14.7) |
| Age at the time of diagnosis (years) | 26.0 (± 14.8) | 27.2 (± 14.9) | 25.5 (± 14.7) |
| Duration of psoriasis (years) | 23.3 (± 13.9) | 25 (± 13.6) | 22.6 (± 14) |
| Family history of psoriasis | 137 (39%) | 43 (43%) | 94 (37.5%) |
| BMI (kg/m2) | 28.6 (± 5.1) | 29.5 (± 4.9) | 28.3 (± 5.1) |
| BMI category | |||
| Underweight (18.5 kg/m2) | 1 (0.3%) | 0 (0%) | 1 (0.4%) |
| Normal (18.5–24.99 kg/m2) | 76 (21.7%) | 16 (16%) | 60 (23.9%) |
| Overweight (25–29.99 kg/m2) | 155 (44.2%) | 46 (46%) | 109 (43.4%) |
| Obese (30 kg/m2) | 119 (33.9%) | 38 (38%) | 81 (32.3%) |
| Smoking | |||
| Non-smokers | 158 (45%) | 37 (37%) | 121 (48.2%) |
| Active smokers | 131 (37.3%) | 44 (44%) | 87 (34.7%) |
| Ex smokers | 62 (17.7%) | 19 (19%) | 43 (17.1%) |
| Psoriasis location | |||
| Scalp | 272 (77.5%) | 75 (75%) | 197 (78.5%) |
| Nails | 178 (50.7%) | 67 (67%) | 111 (44.2%) |
| Genitals | 69 (19.7%) | 25 (25%) | 44 (17.5%) |
| PASI | 5.3 (± 7.2) | 5.2 (± 6.3) | 5.3 (± 7.6) |
| Systemic/topical therapy | |||
| Acitretin | 15 (4.3%) | 4 (4%) | 11 (4.4%) |
| Metotrexate | 79 (22.5%) | 28 (28%) | 51 (20.3%) |
| Cyclosporine | 4 (1.1%) | 0 (0%) | 4 (1.6%) |
| Phototherapy | 15 (4.3%) | 3 (3%) | 12 (4.8%) |
| Local therapy | 76 (21.7%) | 15 (15%) | 61 (24.3%) |
| Biological/targeted therapy | 178 (50.7%) | 62 (62%) | 116 (46.2%) |
| Adalimumab | 55 (15.7%) | 17 (17%) | 38 (15.1%) |
| Apremilast | 6 (1.7%) | 3 (3%) | 3 (1.2%) |
| Brodalumab | 20 (5.7%) | 8 (8%) | 12 (4.8%) |
| Certolizumab pegol | 2 (0.6%) | 2 (2%) | 0 (0%) |
| Etanercept | 11 (3.1%) | 8 (8%) | 3 (1.2%) |
| Guselkumab | 18 (5.1%) | 5 (5%) | 13 (5.2%) |
| Ixekizumab | 15 (4.3%) | 7 (7%) | 8 (3.2%) |
| Risankizumab | 16 (4.6%) | 1 (1%) | 15 (6%) |
| Secukinumab | 17 (4.8%) | 7 (7%) | 10 (4%) |
| Ustekinumab | 18 (5.1%) | 4 (4%) | 14 (5.6%) |
| Arthrosis | 16 (4.6%) | 12 (12%) | 4 (1.6%) |
| Arthrosis and gout | 1 (0.3%) | 0 (0%) | 1 (0.4%) |
| Gout | 1 (0.3%) | 0 (0%) | 1 (0.4%) |
Values are mean (± SD) or N (%)
BMI body mass index
Treatment History
Regarding treatment, 76 (21.7%) patients were on topical therapy. A total of 178 (50.7%) patients were on targeted therapy (biologics and small molecules) and 113 (49.3%) were on systemic therapy. Fifteen patients were on acitretin therapy (4.3%), 79 (22.5%) on methotrexate, 4 (1.1%) on cyclosporine, and 15 (4.3%) were treated with phototherapy. The most commonly prescribed targeted therapy was adalimumab (15.7%), followed by brodalumab (5.7%), guselkumab and ustekinumab (5.1%), with three other agents having approximately equal representation (secukinumab 4.8%, risankizumab 4.6%, ixekizumab 4.3%), etanercept (3.1%), and the lowest number of patients being on certolizumab pegol (0.6%). Apremilast, an oral small molecule, was used by 6 (1.7%) of responders (Table 1).
Clinical Characteristics and PEST Questionnaire
A total of 100 patients (28.5%) had a positive PEST questionnaire; 13.1% of participants scored 3, 8% scored 4, and 7.4% scored 5 (Fig. 1). Sixty-three were male with an average age of 52.3 (SD 11.6) and duration of psoriasis was 25 (SD 13.6) years compared to 22.6 (SD 14) in the negative group. The average age at the time of diagnosis was 27.2 (SD 14.9) years, while in the group of negative PEST mean age was 48.2 (SD 14.7). PEST was most frequently positive in the age group of 50–60 years (42%), followed by 22% in the age group of 40–50 years. Negative PEST results were most common in the age groups of 30–40 and 40–50 years (23% each) (Fig. 2). Scalp psoriasis was present in 75%, nails in 67%, and genitals in 25% of patients with positive PEST in comparison with 78.5%, 44.2%, 17.5% in participants with negative PEST, respectively. Among 100 patients with positive PEST questionnaire, 62 (62%) were on biological/targeted therapy in comparison with 46.2% in the negative group (116 patients out of 251). In terms of the presence of other joint diseases such as osteoarthritis or gout, up to 12% of patients with osteoarthritis had a positive PEST. None of the individuals in the positive group had gout. In the negative PEST group, 1.6% had arthrosis, 1 patient (0.4%) was had a combination of arthrosis and gout, and similarly only 1 patient (0.4%) suffered from gout (Table 1).
Fig. 1.
Results of PEST questionnaire. 13.1% had a score of 3, 8.0% a score of 4, and 7.4 a score of 5
Fig. 2.
Positive and negative PEST results according to the age categories
By using logistic regression we attempted to identify variables that could influence the positivity of the PEST. Our data revealed age, nail involvement, and the utilization of biological/targeted therapy as statistically significant indicators for PEST positivity: p values were 0.044 for age (HR 1.02, 95% CI 1.00–1.04), less than 0.001 for nail involvement (HR 2.71, 95% CI 1.63–4.56), and 0.003 for use of biologic/targeted therapy (HR 2.33, 95% CI 1.33–4.15) (Fig. 3).
Fig. 3.
Logistic regression for statistically significant attributes of PEST positivity
The most common positive response was recorded for question 3 regarding the presence of nail pitting—51.3% (180 patients). The second most common positive response was to the question number 1 concerning joint swelling (32.2%), followed by nearly the same percentage of positive responses for finger or toe swelling in question 5 (31.6%). The least frequent positive responses were to question 4, asking about heel pain (26.5%) (Fig. 4).
Fig. 4.
Analysis of frequency of positive responses to individual questions in the PEST questionnaire
Analysis of Individual Questions on Positive and Negative PEST Questionnaires
In the group with positive questionnaires, the most common positive response was on nail pitting (85%), followed by joint swelling (82%), and by question 5—completely swollen and painful finger of toe for no apparent reason (79%). A total of 68% of patients with a positive PEST questionnaire responded positively to question 2 regarding a history of arthritis, while the least positive responses (66%) were reported for heel pain.
Among patients with a negative PEST score, the most common positive response was to the question related to nail pitting (37.8%). Questions 1, 2, and 5 garnered positive responses at a similar rate, 12.4% for question 1 and 12.7% for both 2 and 5, while question 4 received the lowest frequency (10.8%) (Fig. 5).
Fig. 5.
PEST questionnaire answers by categories in patients with positive and negative results
Discussion
The goal of our study was to analyze the PEST questionnaire in routine clinical practice among a randomly selected population of patients with psoriasis and without diagnosed PsA. Positive PEST questionnaire was found in 28.5% of patients within our cohort which is quite similar to the prevalence of PsA in patients with psoriasis [4]. Screening questionnaires increase the possibility of diagnosing PsA early, which is extremely important for the prognosis of the disease, since a delay in diagnosis may lead to irreversible joint changes.
Higher risk of having a positive PEST was found in patients with nail psoriasis, higher age, and being treated with biological/targeted therapy. All three of these attributes have a logical explanation. Different studies have shown that nail psoriasis is associated with higher risk of PsA [16, 17]. Nail involvement was the most common positive response in the PEST questionnaire (51.3%) and these patients were 2.71 times more likely to have a positive PEST. Higher age means that the patient may have had psoriasis for a long time. According to available retrospective study results, the average time interval between the onset of skin psoriasis and the onset of PsA is 14.6 ± 12.6 years [18]. In our study patients with positive PEST had psoriasis for an average of 25 years (± 13.6). Higher age was associated with positive PEST in the study by Mease et al. [15]; they also reported that female gender was associated with positive PEST, which was not seen in our study [15]. The use of biological/targeted therapy indicates that the patients have more severe psoriasis which is also associated with higher risk of PsA [19]. This fact was also confirmed by an 8-year prospective study in which a severe phenotype of psoriasis was identified as a statistically significant risk factor (RR 5.4, p = 0.006) [20].
PEST questionnaire is a well-established tool for screening of PsA. The multicentric PREPARE study in Europe and North America confirmed the utility of using screening questionnaires (PASQ, PEST, and ToPAS) in the early identification of patients at risk of PsA. These questionnaires indicated possible PsA in 43–45% of patients with psoriasis, with subsequent rheumatological assessment confirming the diagnosis in 30% of patients; sensitivity ranged from 67% to 84%, and specificity from 64% to 75% [12]. A study by Chang et al. also suggests that a two-step screening algorithm combining the PEST questionnaire and CASPAR criteria leads to early referral, evaluation, and treatment of PsA by rheumatologists [14]. Additionally, according to an observational retrospective study in Japan, a PEST score higher than 3 indicates an increased risk of PsA (sensitivity 93.1%, specificity 78.9%) [21].
The limitations of this study are the absence of a control group and that data collection were from an unselected sample of patients at a single center on ongoing therapy including systemic, which could have a positive effect in slowing or preventing the joint involvement. A study by Gisondi et al. compared phototherapy with biologic therapy and the results showed that patients treated with biologics had a lower risk of developing PsA [22]. Similar results have been described by Austrian colleagues and also in the IVEPSA study, which showed that early intervention with secukinumab in specific groups of patients can slow or prevent the evolution of PsA [23, 24]. This is what makes screening for PsA crucial, and so PEST is suggested to be used annualy in every patient with psoriasis.
Our data collection in routine clinical practice using only an observational manner could have led to confounding and selection bias. On the other hand, this approach analyzed a group of patients without selection, as encountered in routine clinical practice. A positive PEST result in these patients should lead to referral to a rheumatologist who should confirm or exclude diagnosis of PsA or decide that the patient should be followed. The relatively small number of patients in our cohort could be a limitation but we consider the number of patients (351) enough for preliminary results. Further data with a larger number of patients, preferably of a prospective nature, with subsequent rheumatological assessment, are needed to validate our findings.
Conclusion
The results of this observational study show the practical utility of using the PEST questionnaire in routine clinical dermatological practice. The PEST questionnaire is a simple and understandable tool to identify patients at risk of having PsA. Early detection of potential PsA and referral for rheumatological assessment and early treatment can prevent the development of irreversible, persistent joint changes. Therefore, within the scope of clinical dermatological examination, dermatologists should focus on nail examination (particularly pitting) and should routinely administer the PEST questionnaire, especially to patients with higher age and on targeted systemic therapy.
Acknowledgements
We thank the participants of the study.
Author Contributions
Simona Tivadar, Spyridon Gkalpakiotis, Jan Hugo and Kristina Fuzesiova contributed to data collection, analysis and interpretation, and manuscript development. Barbora Turkova and Tomas Dolezal to statistic analysis and interpretation.
Funding
This work was supported by the Charles University research Cooperatio 34, Internal Disciplines.
Data Availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Conflict of Interests
Simona Tivadar has served as investigator for Novartis. Jan Hugo has served as consultant and speaker for AbbVie, Amgen, Eli Lilly, Janssen Cilaq, LEO Pharma, Novartis, Pfizer, and UCB. Kristina Fuzesiova has served as a speaker for AbbVie, Eli Lilly and UCB. Tomáš Doležal has served as a speaker and consultant for AbbVie, Amgen, Eli Lilly, Janssen Cilaq, LEO Pharma, Novartis, Pfizer, and UCB. Barbora Turkova has nothing to declare. Spyridon Gkalpakiotis has served as consultants, speakers, or investigators for AbbVie, Amgen, Eli Lilly, Janssen Cilaq, LEO Pharma, Novartis, Pfizer, and UCB.
Ethical Approval
The study was conducted in accordance with the Helsinki Declaration of 1964 and all subsequent amendments, and all patients provided informed consent. The study was approved by the ethical committee of the University Hospital Kralovske Vinohrady under the number EK-VP /08/00/2024.
References
- 1.Ohara Y, Kishimoto M, Takizawa N, et al. Prevalence and clinical characteristics of psoriatic arthritis in Japan. J Rheumatol. 2015;42(8):1439–42. 10.3899/jrheum.141598. [DOI] [PubMed] [Google Scholar]
- 2.Kishimoto M, Deshpande GA, Fukuoka K, et al. Clinical features of psoriatic arthritis. Best Pract Res Clin Rheumatol. 2021;35(2):101670. 10.1016/j.berh.2021.101670. [DOI] [PubMed] [Google Scholar]
- 3.Ritchlin CT, Colbert RA, Gladman DD. Psoriatic arthritis. N Engl J Med. 2017;376(10):957–70. 10.1056/NEJMra1505557. [DOI] [PubMed] [Google Scholar]
- 4.Alinaghi F, Calov M, Kristensen LE, et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol. 2019;80(1):251-265.e19. 10.1016/j.jaad.2018.06.027. [DOI] [PubMed] [Google Scholar]
- 5.Gladman DD. Axial psoriatic arthritis. Curr Rheumatol Rep. 2021;23(6):35. 10.1007/s11926-021-00999-8. [DOI] [PubMed] [Google Scholar]
- 6.Pitzalis C. Skin and joint disease in psoriatic arthritis: what is the link? Br J Rheumatol. 1998;37:480–3. 10.1093/rheumatology/37.5.480. [DOI] [PubMed] [Google Scholar]
- 7.Haroon M, Gallagher P, FitzGerald O. Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis. Ann Rheum Dis. 2015;74(6):1045–50. 10.1136/annrheumdis-2013-204858. [DOI] [PubMed] [Google Scholar]
- 8.Hioki T, Komine M, Ohtsuki M. Diagnosis and intervention in early psoriatic arthritis. J Clin Med. 2022;11(7):2051. 10.3390/jcm11072051. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Coates LC, Moverley AR, McParland L, et al. Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015;386(10012):2489–98. 10.1016/S0140-6736(15)00347-5. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Villani AP, Rouzaud M, Sevrain M, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: systematic review and meta-analysis. J Am Acad Dermatol. 2015;73(2):242–8. 10.1016/j.jaad.2015.05.001. [DOI] [PubMed] [Google Scholar]
- 11.Coates LC, Savage LJ, Chinoy H, et al. Assessment of two screening tools to identify psoriatic arthritis in patients with psoriasis. J Eur Acad Dermatol Venereol. 2018;32(9):1530–4. 10.1111/jdv.14971. [DOI] [PubMed] [Google Scholar]
- 12.Mease PJ, Gladman DD, Helliwell P, et al. Comparative performance of psoriatic arthritis screening tools in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2014;71(4):649–55. 10.1016/j.jaad.2014.05.010. [DOI] [PubMed] [Google Scholar]
- 13.Ibrahim GH, Buch MH, Lawson C, et al. Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire. Clin Exp Rheumatol. 2009;27(3):469–74. [PubMed] [Google Scholar]
- 14.Chang J, Litvinov IV, Ly C, et al. Utilization of the Psoriasis Epidemiology Screening Tool (PEST): a risk stratification strategy for early referral of psoriatic arthritis patients to minimize irreversible erosive joint damage. J Cutan Med Surg. 2022;26(6):600–3. 10.1177/12034754221128796. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Mease PJ, Palmer JB, Hur P, et al. Utilization of the validated Psoriasis Epidemiology Screening Tool to identify signs and symptoms of psoriatic arthritis among those with psoriasis: a cross-sectional analysis from the US-based Corona Psoriasis Registry. J Eur Acad Dermatol Venereol. 2019;33(5):886–92. 10.1111/jdv.15443. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Raposo I, Torres T. Nail psoriasis as a predictor of the development of psoriatic arthritis. Actas Dermosifiliogr. 2015;106(6):452–7. 10.1016/j.ad.2015.02.005. [DOI] [PubMed] [Google Scholar]
- 17.Zabotti A, De Lucia O, Sakellariou G, et al. Predictors, risk factors, and incidence rates of psoriatic arthritis development in psoriasis patients: a systematic literature review and meta-analysis. Rheumatol Ther. 2021;8(4):1519–34. 10.1007/s40744-021-00378-w. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Alonso S, Tejón P, Sarasqueta C, et al. Age at disease onset may help to further characterize the disease phenotype in psoriatic arthritis. Joint Bone Spine. 2016;83(5):533–7. 10.1016/j.jbspin.2015.09.004. [DOI] [PubMed] [Google Scholar]
- 19.Pouw JN, Jacobs ME, Balak DMW, et al. Do patients with psoriatic arthritis have more severe skin disease than patients with psoriasis only? A systematic review and meta-analysis. Dermatology. 2022;238(6):1108–19. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Eder L, Haddad A, Rosen CF, et al. The incidence and risk factors for psoriatic arthritis in patients with psoriasis: a prospective cohort study. Arthritis Rheumatol. 2016;68(4):915–23. 10.1002/art.39494. [DOI] [PubMed] [Google Scholar]
- 21.Setoyama A, Sawada Y, Saito-Sasaki N, et al. Psoriasis epidemiology screening tool (PEST) is useful for the detection of psoriatic arthritis in the Japanese population. Sci Rep. 2021;11(1):16146. 10.1038/s41598-021-95620-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Gisondi P, Bellinato F, Targher G, et al. Biological disease-modifying antirheumatic drugs may mitigate the risk of psoriatic arthritis in patients with chronic plaque psoriasis. Ann Rheum Dis. 2022;81(1):68–73. 10.1136/annrheumdis-2021-219961. [DOI] [PubMed] [Google Scholar]
- 23.Graier T, Salmhofer W, Jonak C, et al. Evolution of characteristics and biologic treatment effectiveness in patients of the Austrian psoriasis registry from 2004–2022. J Dtsch Dermatol Ges. 2023;21(12):1513–23. 10.1111/ddg.15213. [DOI] [PubMed] [Google Scholar]
- 24.Kampylafka E, Simon D, d’Oliveira I, et al. Disease interception with interleukin-17 inhibition in high-risk psoriasis patients with subclinical joint inflammation-data from the prospective IVEPSA study. Arthritis Res Ther. 2019;21(1):178. 10.1186/s13075-019-1957-0. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.