Background The Psoriasis Epidemiology Screening Tool (PEST) is a 5-item questionnaire developed to help identify psoriatic arthritis (PsA) at an early stage, with a score ≥3 indicative of PsA.1 A recent Korean study found that a PEST score of 2 may be a more favorable cutoff for screening patients with psoriasis (PsO).2
Objectives To assess the risk of undiagnosed PsA among patients with PsO and characterize patients based on PEST scores in a US cohort.
Methods This study included all patients enrolled in the Corrona PsO Registry with data on all 5 PEST questions. Demographics, disease characteristics, patient-reported outcomes (PROs) and medication use were analyzed at the time of enrollment and stratified by PEST score (0, 1, 2 or ≥3). Pairwise comparisons were made between PEST score =0 (reference) and other PEST score groups using t-tests for continuous variables and χ2 tests for categorical variables.
Results As of June 2016, 99.1% (1516/1529) of patients in the Corrona PsO Registry had data on all 5 PEST questions; 612 patients (40.4%) had dermatologist-reported PsA at enrollment. Among the remaining 904 patients, 421 patients (46.6%) had a PEST score =0, 225 (24.9%) had a PEST score =1, 146 (16.2%) had a PEST score =2 and 112 (12.4%) had a PEST score ≥3. Of patients with a PEST score ≥3, patients most commonly answered “yes” to “have you ever had a swollen joint (or joints)?” (89%) and “has a doctor ever told you that you have arthritis?” (86%). Compared with patients with a PEST score =0, patients with a PEST score ≥1 all had a higher BMI, longer duration of PsO, increased family history of PsA, increased prevalence of nail PsO and worse EQ-VAS at enrollment (all P<0.05; Table 1). In addition, patients with PEST scores ≥2 were older, more likely to be female, less likely to be employed and had an increased family history of PsO, worse pain and fatigue, worse dermatology-related quality of life and higher percentage impairment of daily activities due to psoriasis at enrollment vs patients with a PEST score =0 (all P<0.05). There were no significant differences across PEST scores in affected body surface area or PASI scores.
Conclusions In this cohort of PsO patients with no diagnosis of PsA, patients with PEST scores ≥2 were significantly different from those with PEST scores =0 for many characteristics at enrollment, including BMI and PROs. These findings highlight the value of screening for PsA among patients with PsO in order to potentially improve patient outcomes.
) Ibrahim GH, et al. Clin Exp Rheumatol. 2009;27(3):469–74.
) Ha YJ, et al. Arthritis Rheumatol. 2016;68(suppl 10):A2744.
Acknowledgements The Corrona Psoriasis Registry is sponsored by Corrona, LLC and is funded by AbbVie, Boehringer Ingelheim, Eli Lilly and Company and Novartis Pharmaceuticals Corporation. Corrona, LLC has been supported through contracted subscriptions in the last two years by AbbVie, Amgen, AstraZeneca, BMS, Crescendo, Eli Lilly and Company, Genentech, GSK, Horizon Pharma USA, Janssen, Momenta Pharmaceuticals, Novartis, Pfizer, Roche and UCB.
Disclosure of Interest P. Mease Grant/research support from: Celgene, Novartis, AbbVie, Amgen, BMS, Lilly, Pfizer and UCB, Consultant for: Celgene, Corrona, Novartis, AbbVie, Amgen, BMS, Crescendo, Genentech, Janssen, Lilly, Merck, Pfizer and UCB, Speakers bureau: AbbVie, Amgen, BMS, Crescendo, Celgene, Genentech, Janssen, Pfizer and UCB, J. Palmer Employee of: Novartis, M. Lebwohl Employee of: Mount Sinai, which received research funds from Amgen, Anacor, Boehringer Ingelheim, Celgene, Lilly, Janssen Biotech, Kadmon, LEO Pharmaceuticals, MedImmune, Novartis, Pfizer, Sun Pharmaceuticals and Valeant, C. Karki Employee of: Corrona, LLC, G. Reed Shareholder of: Corrona, LLC, Employee of: Corrona, LLC, C. Etzel Consultant for: Merck, Employee of: Corrona, LLC, J. Greenberg Shareholder of: Corrona, LLC, Consultant for: Eli Lilly, Genentech, Janssen, Novartis and Pfizer, Employee of: Corrona, LLC, P. Helliwell Consultant for: Amgen, BMS, Janssen, Lilly, Pfizer and UCB, Speakers bureau: Novartis, AbbVie, Janssen, Lilly, Pfizer and UCB