The PASE questionnaire: Pilot-testing a Psoriatic Arthritis Screening and Evaluation tool

doi:10.1016/j.jaad.2007.04.001

Journal of the American Academy of Dermatology

Volume 57, Issue 4, October 2007, Pages 581-587

https://doi.org/10.1016/j.jaad.2007.04.001 Get rights and content

Background

Complications associated with psoriatic arthritis (PsA) may be prevented with early diagnosis and initiation of therapy. Up to one third of psoriasis patients may have PsA. There is a need to screen psoriasis patients early for symptoms of PsA.

Objective

To develop and validate a patient self-administered tool to screen psoriasis patients for signs and symptoms of inflammatory arthritis.

Methods

The questionnaire (PASE; Psoriatic Arthritis Screening and Evaluation) was developed using standardized methodology for the development of both functional and health-related instruments geared toward musculoskeletal diseases. A multidisciplinary team of dermatologists, rheumatologists, and patient focus groups were involved in the design of the questionnaire.

Results

A total of 69 participants with known psoriasis and PsA before the initiation of systemic therapy were screened with PASE after institutional review board approval. The average age was 51 years, and 51% of the participants were female. A total of 25% (17/69) were diagnosed with PsA in this study, and 37% (24/69) were diagnosed with osteoarthritis. Patients with concomitant PsA and osteoarthritis were excluded. PASE total scores ranged from 23 to 68 (possible range, 15-75). In patients with PsA, the median total score was 53 (25th and 75th percentiles, 49 and 63, respectively) and 39 (25th and 75th percentiles, 28 and 47) in non-PsA patients (P < .001). Median PASE total score for osteoarthritis patients was 43 (25th and 75th percentiles, 37 and 51) and significantly different to PsA patient total median scores (P = .002). Using receiver operator curves, we determined that PASE total score ≥47 was able to distinguish PsA from non-PsA patients with 82% sensitivity and 73% specificity.

Limitations

PASE is a screening tool for PsA and does not replace a comprehensive musculoskeletal evaluation by a rheumatologist.

Conclusion

The PASE questionnaire is a self-administered tool that can be used to screen for PsA among patients with psoriasis. PASE can distinguish between symptoms of PsA and osteoarthritis. A larger study is needed to validate PASE in dermatology clinics in the community.

Section snippets

Instrument design

An initial question pool was generated from a review of the literature, patient data available from multi-center studies, informal open patient interviews, and expert opinion from rheumatologists and dermatologists as has been done previously using a Delphi method.¹⁶ Measurement goals were specified; an initial pool of 34 items was generated after a 1-round Delphi process involving institutional dermatologists and rheumatologists who were experts or had a special interest in psoriasis and PsA.

Results

Responses from a total of 69 patients who were administered the PASE questionnaire when presenting to the Center for Skin and Related Musculoskeletal Diseases were analyzed (Table I). All study participants had to have a diagnosis of psoriasis to be included in the study and be self-administered the PASE questionnaire at the time of visit to the clinic. The average age was 51 years, and 51% were female. The average age in the PsA group was 45 years; in the non-PsA group, the average age was 53

Discussion

The major goal of this study was to establish and pilot test a self-administered questionnaire to help dermatologists and other healthcare providers who treat psoriasis patients screen for PsA. The diagnosis of PsA using this questionnaire alone is not the goal of this work. The combined dermatology-rheumatology clinic and close working relationship between the two specialties served as an optimal test-bed for development of this tool. PASE is not designed or intended to substitute for a

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: Supported by a grant from the Department of Dermatology, Brigham and Women's Hospital (to A. A. Q.).

: Disclosure: Dr Qureshi is a consultant for and has spoken for Abbott, Amgen, and Genentech, and has had a limited consulting relationship with Centocor. Dr Mody is a speaker for Abbott, Amgen, and Genentech. Dr Husni is a consultant for Genentech and Amgen. Ms Meyer and Dr Cohen have no conflicts of interest to declare.

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ReportThe PASE questionnaire: Pilot-testing a Psoriatic Arthritis Screening and Evaluation tool

Background

Objective

Methods

Results

Limitations

Conclusion

Section snippets

Instrument design

Results

Discussion

J Am Acad Dermatol

Dermatol Clin

Semin Arthritis Rheum

Development of diagnostic criteria for psoriatic arthritis: methods and process

Curr Rheumatol Rep

Psoriatic arthritis: performance of rheumatologists in daily practice

Ann Rheum Dis

Psoriatic arthritis and psoriasis: need for a multidisciplinary approach

Semin Cutan Med Surg

Management of psoriatic arthritis: the therapeutic interface between rheumatology and dermatology

Curr Rheumatol Rep

Recent advances in the management of psoriatic arthritis

Curr Opin Rheumatol

Diagnosis and management of psoriatic arthritis

Drugs

Report
The PASE questionnaire: Pilot-testing a Psoriatic Arthritis Screening and Evaluation tool