Assessing the Accuracy of Questionnaire-Based Screening Tools for Detection of Psoriatic Arthritis

Hand with PsA
Hand with PsA
Researchers reviewed the accuracy and characteristics of questionnaire-based PsA screening tools.

Questionnaire-based screening tools have demonstrated moderate accuracy to detect psoriatic arthritis (PsA) in patients with psoriasis, according to results from a study published in Rheumatology.

In this systematic review and meta-analysis, researchers searched major databases for studies that assessed the accuracy of self-administered PsA detection tools in patients with psoriasis. In terms of eligibility, no restrictions were placed on inclusion criteria with respect to study design or type of screening tool because there is no gold standard reference test for PsA. After applying the inclusion criteria, investigators found 27 applicable studies from which data were extracted and analyzed.

After quantitative analysis, investigators found that within the applicable studies, there were 104 separate accuracy estimates for PsA, which included 14 individual screening tools. Taken together, 37% of the applicable studies showed a low risk for bias. In addition, the researchers calculated estimates of specificity and sensitivity for several of these tools, including the Toronto Psoriatic Arthritis Screening test, Psoriasis Epidemiology Screening Tool, and The Early Psoriatic Arthritis Screening Questionnaire, which exhibited the highest scores for screening accuracy of all detection tools.

A primary limitation of this review was the high estimates of heterogeneity between each detection tool in the meta-analysis.

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The investigators wrote, “these tools have a moderate capability to identify PsA, [but] it is imperative to determine whether implementing screening procedures (and diagnostic and treatment follow-ups) are cost-effective.”

“An economic evaluation could model the uncertainty and estimate the cost-effectiveness of PsA screening programs that use different tools,” they concluded.

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Iragorri N, Hazlewood G, Manns B, Danthurebandara V, Spackman E. Psoriatic arthritis screening: a systematic review and meta-analysis [published online October 31, 2018]. Rheumatology (Oxford). doi: 10.1093/rheumatology/key314.