Background Psoriatic arthritis (PsA) is frequently underdiagnosed by dermatologists due to it's heterogeneous clinical manifestations such as peripheral arthritis, dactylitis, spondylitis and enthesitis. For the correct early diagnosis, choice of treatment and for better outcomes proper evaluation of all symptoms is required.
Objectives to compare the definition of the main clinical symptoms of PsA by dermatologists and rheumatologists in daily clinical practice.
Methods 103 pts (male-47/female-56) with different forms of plaque psoriasis (PsO), mean age 44±13.69 years (yrs.), mean psoriasis duration 10.7±10.2 yrs., mean PASI 5.05±1.23 were included. In dermatological clinic, all pts completed a PEST questionnaire and underwent clinical evaluation by a dermatologists in order to identify the main clinical symptoms of PsA such as peripheral arthritis, dactylitis, spondylitis and enthesitis. Later all pts were subsequently evaluated by rheumatologists to confirm/exclude the diagnosis of PsA based on CASPAR criteria and underwent standard clinical examination to identify the same symptoms - peripheral arthritis, dactylitis, spondylitis (based on inflammatory back pain (IBP) ASAS criteria) and enthesitis (based on Leeds Enthesial Index (LEI) plus Plantar Fascia (PF). M±m, %, t-test were peformed. All p<0.05 were considered to indicate statistical significance.
Results 61 out of 103 pts with PsO (59.2%) had PsA based on rheumatological evaluation and CASPSR criteria. Dermatologists diagnosed peripheral arthritis in significantly less cases compared to rheumatologists: in 15 (24.6%) and in 35 (57.4%) out of 61 pts (p<0.001) accordingly. No significant difference was seen in clinical evaluation of dactylitis by dermatologists or rheumatologists - in 37 (60.7%) and in 40 (65.6%) out of 61 pts accordingly (p=0.32). Heel pain was noted by dermatologists in 32 out of 61 pts (52.5%) according to PEST questionnaire. Dermatologists could not find enthesitis according to LEI. Rheumatological examination based on LEI scale identified lateral epicondyles in 11 out of 61 pts (18%), enthesitis of medial femoral condyles in 8 out of 61 pts (13.1%), enthesitis of Achilles tendon insertions – in 25 out of 61 pts (41%). Enthesitis of PF were observed in 15 out of 61 pts (24.6%). Dermatologists noted back pain using PEST questionnaire in 30 out of 61 pts (49.2%). IBP based on ASAS criteria was not detected by a dermatologists in any case. In these 30 pts having back pain IBP was diagnosed by a rheumatologists in 21 (70%) cases; and in the rest 9 out of 30 pts (30%) mechanical back pain was observed. On the basis of clinical examination tendinitis was not noted by dermatologists, while rheumatologists found hand tendinitis in 13 out of 61 pts (21.3%).
Conclusions Perypheral arthrtitis, axial and enthesial involvement were underestimated by dermatologists using PEST screening questionnaire, because it does not cover these symptoms in detail. ASAS criteria for IBP and standard enthesitis assessment should be implemented into Russian dermatological clinical practice. In order to improve early PsA diagnosis in dermatological practice, interdisciplinary educational training programmes and collaboration with rheumatologists are needed.
Disclosure of Interest None declared
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