Clinical Symptoms of Skin, Nails, and Joints Manifest Independently in Patients with Concomitant Psoriasis and Psoriatic Arthritis

Abstract

This study correlated assessment tools for evaluating the severity of skin, nail, and joint symptoms in patients with psoriasis (Pso) and psoriatic arthritis (PsA). Adults with plaque Pso (with or without PsA) were enrolled from four U.S. institutions. Patients were evaluated using a novel 10-area Linear Psoriasis Area and Severity Index (XL-PASI), Psoriatic Arthritis Assessment (PsAA), Psoriatic Arthritis Screening and Evaluation Questionnaire (PASE), Nail Assessment (NA) and Joint Assessment (JA) tools, Psoriasis Weighted Extent and Severity Index (PWESI), and Lattice Physician Global Assessment (LS-PGA). Correlations between assessment tools and individual items in the assessment tools were performed. Data from 180 patients (55 with PsA) were analyzed. Highest correlations between tools (r = 0.77–0.88) were between the XL-PASI, PWESI and LS-PGA. Individual items in the XL-PASI correlated with items in the PWESI for extent skin symptoms, but not for all body areas. Overall, correlations were seen between hands and feet, between face and scalp, and between buttocks, chest, and back. Only low correlation was seen between items assessing joint symptoms with items assessing skin symptoms. These data support the notion that the complex phenotype of psoriatic disease requires instruments that assess the severity of skin, nails, and joints separately.

Promoting patient‐centred care in psoriatic arthritis: a multidisciplinary European perspective on improving the patient experience

“…Moreover, the predictive nature of clinical observations such as the severity of psoriasis (as measured by the Psoriasis Area Severity Index [PASI]), the severity of joint involvement and the presence of certain psoriasis features (e.g. scalp lesions, nail disease and intergluteal/perianal psoriasis) with respect to the risk of developing PsA remains unclear 10, 13, 14, 15. Determining such absolute indicators for PsA remains complicated because of varying study designs (e.g.…”

Current Concepts in Psoriatic Arthritis: Pathogenesis and Management

“…Similarly, in European dermatology clinic patients, greater body surface area (BSA) involvement, both at the time of the study assessment and within 6 months after psoriasis diagnosis, was associated with PsA risk (10). However, the extent and severity of psoriasis quantified by the Psoriasis Area and Severity Index (PASI) do not correlate with the severity of PsA joint disease (11). Specific psoriasis features independently associated with PsA risk include scalp lesions (by 3.75-fold), nail dystrophy (by 2.24-fold), and intergluteal/ perianal lesions (by 1.95-fold) (12).…”

Psoriasis and Psoriatic Arthritis: Flip Sides of the Coin?

“…The International Psoriasis Council investigated the same question, by applying sets of assessment tools for symptoms of skin, nails and joints in 180 patients with PsO and PsA. Good correlations amongst the results obtained for activity and severity measurements of skin or joint symptoms were observed using these sets of tools, while there was again no correlation between tools assessing different domains (9).…”