Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Prevalence of Psoriatic Arthritis in Dermatological Patients with Psoriasis.
Henes1, Joerg C., Eisfelder2, Michael, Adamczyk3, Anette, Knaudt3, Björn, Jacob3, Felix, Zuipa1, Eva-Maria, Denfeld4, Ralf
University Hospital Tuebingen, Tuebingen, Germany
Private practice, Rottweil, Rottweil, Germany
University Hospital Tuebingen, Department of dermatology, Tuebingen, Germany
Private practice, Stuttgart, Germany
Private practice, Tuebingen, Germany
Department of Internal Medicine II, Rheumatology Division, Tübingen, Germany
The existing data on prevalence of psoriatic arthritis (PsA) among patients with psoriasis in the literature vary between 5.8 and 40%. Recently, a new screening questionnaire in German language has been validated by Haerle et al.. This GEPARD (German Psoriasis Arthritis Diagnostic questionnaire) has a sensitivity and specificity of 89% and 69.1% for >=4 questions answered "yes".
Two dermatologic hospitals and 9 private dermatologic practices were involved. All consecutive patients with psoriasis were asked to fill out the questionnaire without the help of the physician and send them to the study centre. All patients with >=4 positive questions were invited for a rheumatological examination. Patients with known PsA (question 7 answered "yes") received a second questionnaire with regard to the history and treatment of PsA. 30% of patients with known arthritis were interviewed by a telephone call and if diagnosis was uncertain were invited for a rheumatological evaluation. Those patients with a positive questionnaire who denied coming were considered as having no arthritis. The rheumatologic assessment consisted of physical examination and laboratory tests including inflammatory markers, rheumatoid factor, anti-CCP antibodies and HLA B27. All patients with peripheral arthralgia received ultrasound of the joints including Doppler and X-ray of hands, feet and affected joints. In those patients with marginal changes or spinal complaints magnetic resonance imaging (MRI) was added. The CASPAR criteria were used for the diagnosis of PsA.
404 questionnaires were evaluated. 204 patients (50.5%) had answered >=4 questions with "yes" of whom 38.2% (n=78) had a known PsA. 126 patients were invited for a clinical examination and 23% (n=29) refused to come. 98 patients with suspected PsA had a clinical evaluation at the study centre. In 49% (n=48) the CASPAR criteria were not fulfilled and in 44.9% (n=44) a new PsA was diagnosed. In two patients anti-CCP antibodies and a symmetrical arthritis made the diagnosis rheumatoid arthritis more plausible. 6.1% already had the diagnosis of PsA. In addition to the clinical evaluation the diagnosis was confirmed by radiological assessment using X-ray in 69.4% (n=68), powerdoppler ultrasound in 83.7% and MRI in 39.8%. All together, of the 404 patients 44 (10.9%) were newly diagnosed having a PsA and 78 (19.3%) had a known PsA whereas 282 (69.8%) were found to have no signs of PsA. Thus the prevalence PsA among patients with psoriasis in this study was 30.2%. There were no significant differences in the patients with or without definite arthritis regarding CRP or ESR, HLAB27, gender or severity of psoriasis. Only dactylitis was significantly associated with definite PsA.
This study uses a validated questionnaire in the forefront of a clinical evaluation in patients with suspected PsA. By using this approach the prevalence of PsA was higher than that in recent studies in Germany, UK and the United States and supports findings from Scandinavia. With nearly 50% positive questionnaires for patients without PsA the specificity should be improved.
To cite this abstract, please use the following information:
Henes, Joerg C., Eisfelder, Michael, Adamczyk, Anette, Knaudt, Björn, Jacob, Felix, Zuipa, Eva-Maria, et al; Prevalence of Psoriatic Arthritis in Dermatological Patients with Psoriasis. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :532