Comparative Efficacy of Different Triage Methods for Psoriatic Arthritis: Results From a Prospective Study in a Rapid Access Clinic.

Abstract

We undertook this study to identify the optimal combination of triage methods to identify psoriatic arthritis (PsA) among psoriasis patients with musculoskeletal symptoms in a rapid access clinic and to describe their outcome after 1 year. Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their musculoskeletal symptoms. Each patient was assessed by the following 3 triage modalities: 1) assessment by an advanced practice physical therapist; 2) targeted musculoskeletal ultrasound (MSK-US); and 3) PsA screening questionnaires. The patients were then evaluated by a rheumatologist who determined the patient's disease status and classified them into the following groups: not PsA, possibly PsA, or PsA. Patients returned for a 1-year follow-up visit and were reassessed for change in their disease status. Sensitivity and specificity were calculated for each individual modality, as well as for combinations of modalities. A total of 203 patients with psoriasis and musculoskeletal symptoms were enrolled. The percentage of patients classified as having PsA was 8.8%, and 23.6% were converted into the possibly PsA group. There was no significant difference in the individual performance of the modalities. The highest sensitivity was seen with MSK-US (89%), and the highest specificity was found with the Psoriatic Arthritis Screening and Evaluation questionnaire (79%). The addition of MSK-US data improved the performance of the modalities. A total of 9 patients were classified into the PsA group after 1 year. All patient-reported outcome measures had significantly improved at 1 year (P < 0.001). Combining MSK-US with a screening questionnaire for PsA improved the triage of patients with suspected PsA.