Background Prevalence of PsA is substantially higher in patients with plaque PsO and ranges from 5% to 42% across various patient subgroups . Therefore, rheumatologists and dermatologists should recognize signs and symptoms of joint involvement among patients with PsO without diagnosed PsA [2, 3].
Objectives To evaluate the prevalence of joint symptoms and frequency of joint exams for patients with plaque PsO without PsA in France, Germany, Italy, Spain, and the UK.
Methods This analysis was based on data from the Adelphi 2011 and 2013 Psoriasis Disease Specific Programme, a multi-national, cross-sectional survey of dermatologists and their patients with PsO in five EU countries. Patients with suspected or confirmed PsA were excluded from the analysis. Joint involvements or symptoms were reported separately from both patients and physicians, while joint exams were reported by physicians via conducting chart reviews. Clinical and health-related quality of life (HRQoL) parameters were compared between patients with physician-reported joint symptoms who did not receive joint exams and those without physician-reported joint symptoms or who had a joint exam. Similar comparisons were made using patient rather than physician-reported joint symptoms. T-tests or Mann-Whitney U tests for numerical variables and chi-square tests or Fisher's exact tests for categorical variables were applied.
Results A total of 3,157 patients (France: 628, Germany: 622, Italy: 669, Spain: 703, UK: 535) were included in the study (mean age 46.2±13.3 [SD], 60.7% male). Overall, 24.0% received joint exams, with wide variations across countries (4.1% UK vs. 36.7% Italy). Physician-reported joint involvement was less frequent than patient-reported joint involvement (8.3% vs. 18.2%). Among those with physician-reported/patient-reported joint involvements, 45.7%/55.9% of patients did not receive a joint exam. Only 3.8% of the entire sample had physician-reported symptoms but no joint exams, while 10.0% had patient-reported symptoms but no joint exams. Patients with physician-reported symptoms but no joint exams had significantly poorer EuroQoL-5D (3L) (EQ-5D) utility scores (0.85 vs. 0.88), greater presenteeism (28.8% vs. 19.3%), and activity impairment (36.6% vs. 25.9%) as measured by the Work Productivity and Activity Index, and more severe psoriasis (Body Surface Area: 21.1% vs. 14.3%) compared with patients without physician-reported symptoms or who had a joint exam (all p<0.05). Similar results were seen when joint symptom data were reported from the patients.
Conclusions Across the five countries, approximately half of the patients with PsO without diagnosed PsA with physician or patient-reported joint involvement did not receive a joint exam. Early diagnostic actions such as referral to a rheumatologist or joint exams could increase recognition of PsA, leading to earlier diagnosis and appropriate treatment.
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Acknowledgements Research funded by Immunex Corporation, a wholly owned subsidiary of Amgen Inc.
Disclosure of Interest T. Makhinova Employee of: Amgen, R. Wood Grant/research support from: Amgen, D. Tang Shareholder of: Amgen, Employee of: Amgen, J. Piercy Grant/research support from: Amgen, S. Lobosco Grant/research support from: Amgen, B. Stolshek Shareholder of: Amgen, Employee of: Amgen, D. Harrison Shareholder of: Amgen, Employee of: Amgen