Comparison of screening questionnaires to identify psoriatic arthritis in a primary-care population: a cross-sectional study

Abstract

Summary Background Many questionnaires are available for assessment of psoriatic arthritis (PsA), but there is little evidence comparing them. Objectives To test the proposed CONTEST questionnaire, which was developed to identify patients with psoriasis who have undiagnosed PsA, and compare it with the validated Psoriasis Epidemiology Screening Tool (PEST) questionnaire in a primary‐care setting. Methods A random sample of adult patients with psoriasis and no diagnosis of arthritis was identified from five general practice surgeries in Yorkshire, U.K. Consenting patients completed both questionnaires and were assessed by a dermatologist and rheumatologist. Diagnosis of PsA was made by the assessing rheumatologist. Receiver operator characteristic (ROC) curve analysis examined the sensitivity and specificity of potential cut points. Results In total 932 packs were sent to recruit 191 (20·5%) participants. Of these, 169 (88·5%) were confirmed to have current or previous psoriasis. Using physician diagnosis 17 (10·1%) were found to have previously undiagnosed PsA, while 90 (53·3%) had another musculoskeletal complaint and 62 (36·7%) had no musculoskeletal problems. Using ROC curve analysis, all of the questionnaires showed a significant ability to identify PsA. The area under the curve (AUC) for the CONTEST questionnaires was slightly higher than that of PEST (0·69 and 0·70 vs. 0·65), but there was no significant difference identified. Examining the sensitivities and specificities for the different cut points suggested that a PEST score ≥ 2 would perform better in this dataset, and the optimal scores for CONTEST and CONTEST plus joint manikin were 3 and 4, respectively. Conclusions The accuracy of the questionnaires to identify PsA appeared similar, with a slightly higher AUC for the CONTEST questionnaires. The optimal cut points in this study appeared lower than in previous studies.

Screening for psoriatic arthritis using the Psoriasis Epidemiology Screening Tool questionnaire: examining the optimal cut-off

“…Overall, our results are very much in line with the recently published data by Coates et al ., thereby providing additional validity of these observations. Using the PEST as the sole determinant to refer patients may place a greater burden on the capacity of the rheumatologist, but there are ways of overcoming this challenge.…”

“…The Psoriasis Epidemiology Screening Tool (PEST) is a short screening questionnaire that could guide dermatologist decision making, and Coates et al . have provided evidence that the PEST may be used in both primary and secondary care settings . One key finding is that they have questioned the original PEST cut‐off score that would warrant rheumatologist referral, with their data now suggesting that a lower cut‐off point may be more appropriate .…”

“…2,3 The Psoriasis Epidemiology Screening Tool (PEST) is a short screening questionnaire that could guide dermatologist decision making, 4,5 and Coates et al have provided evidence that the PEST may be used in both primary and secondary care settings. 1,6 One key finding is that they have questioned the original PEST cut-off score that would warrant rheumatologist referral, with their data now suggesting that a lower cut-off point may be more appropriate. 1 Before recommendations can be made on the implementation of alternative cut-off values for the PEST as a diagnostic screening tool, it is essential to verify whether this is equally valid and performs similarly in different clinical settings in different places worldwide.…”

Psoriatic arthritis screening: a systematic review and meta-analysis

“…It provides evidence that the meta-analysed questionnaire screening tools are not only similar to each other in terms of structure, time to complete (between 510 min) [8,10] and validation setting, but also in terms of accuracy. Other questionnaire tools such as the CEPPA, CONTEST and GEPARD have tried to put together different parts of other questionnaires to create a new and improved version [20,27,35]. However, separate studies do not appear to present compelling evidence of superior screening accuracy.…”

Psoriatic arthritis: state of the art review

“…There are significant delays in diagnosis for the majority of patients (typically, in screening studies, up to 50% of established cases have not previously been identified). 7 Delay in diagnoses of 6 and 12 months have been shown to impact on long-term joint damage and functional disability.…”