Epidemiology of Psoriasis in Portugal: A Population-Based Study.

INTRODUCTION: Psoriasis is a common, chronic, and inflammatory skin disorder with a high personal, social and economic burden and important implications for healthcare systems. The aim of this study was to provide an epidemiological characterization of individuals with psoriasis in Portugal. MATERIAL AND METHODS: A large observational, cross-sectional, nationwide, population-based survey study developed by the Portuguese Psoriasis Group of the Portuguese Society of Dermatology and Venereology (GPP-SPDV). A structured questionnaire was designed and applied by experienced interviewers to a random, representative sample of Portuguese individuals with psoriasis and/or psoriatic arthritis. Patients were considered to have psoriasis if they replied positively to one of the following questions: "Does any physician have ever diagnosed you with psoriasis?" or "Do you have a skin disorder characterized by scaling, reddish skin lesions located in the elbows/knees/scalp?". RESULTS: A total of 6381 individuals were interviewed, of which 283 met the criteria for psoriasis, corresponding to a prevalence rate of 4.4% (95% CI 3.95 - 4.98). Out of the participants that met psoriasis criteria, 24% had suggestive signs/symptoms but did not have a clinical diagnosis established and were not being monitored by a physician. Although more than 70% of participants had active disease (scaling, erythema, or pruritus) and one third had joint symptoms, only 12% were on systemic treatment. Fifty percent of participants with psoriasis (n = 139) had relevant comorbidities (most frequently depression/anxiety and cardiometabolic diseases). Sixteen percent of participants with psoriasis (n = 46) reported that psoriasis interfered with their daily activities (median impact of 5 in a 0 - 10 scale) and 12% mentioned the disease had an impact in their sexual life (median impact of 5 in a 0 - 10 scale). CONCLUSION: The results of this study suggest that the prevalence rate of psoriasis is likely to be high in Portugal, and several gaps exist at different levels of healthcare delivery to these patients, from diagnosis to treatment. This study provides important data for the future planning of interventions targeting the improvement of psoriasis care in Portugal.

A Joint Consensus of Rheumatologists and Dermatologists on Early Detection and Effective Management of Psoriatic Arthritis: India's Perspective.

Psoriatic arthritis (PsA) is a chronic inflammatory disease with clinical manifestations, including inflammatory arthritis and the presence of psoriasis (PsO). The present consensus statement evaluated the early diagnosis and treatment approaches in the management of psoriasis and psoriatic arthritis by rheumatologists and dermatologists. For PAN India representation, a panel of eight rheumatologists and five dermatologists from different institutes in India were constituted. These thirteen experts were divided into two groups (rheumatologists group and dermatologist group) who received a set of questionnaires each for diagnosis and treatment approaches in the management of psoriasis and psoriatic arthritis. Based on the responses received, a panel discussion took place, where the experts identified the early diagnostic criteria for PsA considering: Clinical signs and symptoms, and questionnaire-based PsA screening, which includes Psoriasis Epidemiology Screening Tool (PEST) for dermatologists and Classification Criteria for Psoriatic Arthritis (CASPAR) for rheumatologists. The experts also recommended shift from conventional disease-modifying anti-rheumatic drugs (DMARDs) to biologics like secukinumab, when there is extensive skin involvement and TNF inhibitors when there is extensive joint involvement. Overall, the objective of the consensus was to assist rheumatologists and dermatologists in the early diagnosis and management of patients of PsA and PsO in their clinical practice.

Prevalence of Psoriatic Arthritis in Nagano Prefecture, Japan, and Efficacy of the Psoriasis Epidemiology Screening Tool: A Real-World Survey.

Pain, stiffness, and swelling are the main joint symptoms of psoriatic arthritis (PsA); however, they are also common symptoms of other joint diseases. Therefore, it is challenging to distinguish PsA from other joint diseases. To evaluate the prevalence of PsA and the frequency of joint symptoms in psoriasis patients, we conducted a prefecture-wide survey using the Psoriasis Epidemiology Screening Tool (PEST), a patient questionnaire for screening PsA to assess joint symptoms. Data were collected from 764 psoriasis patients, all of whom visited hospitals (55.1%) or clinics (44.9%) in Nagano Prefecture, Japan. The proportion of psoriasis patients with PsA was 6.5% (50 of 764); four patients (1.2%) with PsA were treated in clinics, while 46 patients (10.9%) were treated in hospitals. Based on the responses to the PEST, 18.1% of patients with psoriasis had joint symptoms. In contrast, 73.2% of psoriasis patients with joint symptoms did not have PsA. The PEST showed 52% sensitivity and 93.4% specificity for PsA. In addition, fingernail alterations were common in PsA. The proportion of the population with PsA was lower than reported previously in Japan. This may have been due to the enrollment of a large number of patients treated in clinics. Many patients with PsA were treated at hospitals, which likely reflects the tendency of patients with joint symptoms to receive intensive treatment in hospitals. In addition, based on the lower sensitivity of the PEST in this study, further studies are necessary to establish the validity of the PEST.

Generalized pustular psoriasis (von Zumbusch)

Abstract Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.

Validity and reliability of the Turkish version of Psoriasis Epidemiology Screening Tool for the detection of psoriatic arthritis in patients with psoriasis.

Objectives: The Psoriasis Epidemiology Screening Tool (PEST) is a simple and useful questionnaire designed to screen arthritis in patients with psoriasis. This study aims to evaluate the validity and reliability of the PEST questionnaire in Turkish patients with psoriasis. Patients and methods: Between August 2019 and September 2019, a total of 158 adult patients with psoriasis (61 males, 68 females; mean age: 43.1±13.3 years; range, 29.8 to 56.4 years) who were not previously diagnosed with PsA were included. The testing procedure for translation and cultural adaptation was carried out according to the following steps: preparation, forward translation, reconciliation, back-translation/back-translation review, harmonization, finalization, and proofreading. Patients' demographic parameters, comorbidities, PEST, and Toronto Psoriatic Arthritis Screen (ToPAS 2) results were recorded. The patients were, then, assessed by a rheumatologist who was blinded to their PEST scores. The diagnosis of PsA was made according to the Classification criteria for Psoriatic Arthritis (CASPAR). The receiver operating characteristic (ROC) was assessed to obtain the sensitivity and specificity of the PEST questionnaire. Results: Of the patients, 42 had PsA, while 87 did not. Each parameter of PEST showed a low-high internal consistency ranging from 0.366 to 0.781. When the Question 3 was excluded, Cronbach alpha value increased to 0.866. The Cronbach alpha value of the whole scale was 0.829. The test-retest reliability of the Turkish version of PEST was determined as 0.86 for the total score (ICC=0.866 95% CI: 0.601-0.955; p<0.0001). There was a strong positive correlation between PEST and ToPAS 2 (r=0.763; p<0.001) and a moderate positive correlation between PEST and CASPAR (r=0.455; p<0.001). A cut-off value of ≥3 yielded a sensitivity of 93% and a specificity of 89% for the diagnosis of PsA with the highest Youden's index. The PEST scale was found to have a higher sensitivity, but lower specificity in the head-to-head comparison with ToPAS 2. Conclusion: The Turkish version of PEST is a reliable and valid tool for screening PsA in Turkish patients with psoriasis.

Generalized pustular psoriasis (von Zumbusch).

Generalized pustular psoriasis (von Zumbusch) is a rare and acute eruption characterized by multiple sterile pustules over an erythematous and edematous background, eventually associated with psoriasis vulgaris. Classically, it manifests as a potentially severe systemic picture and demands prompt diagnosis and intervention. The duration of each flare-up and intervals between the pustular episodes is extremely variable. Recently, genetic abnormalities have been identified mainly in the familial and early variants of this disease. The therapeutic arsenal is limited; however, new drugs being evaluated aim to control both pustular flare-ups and disease recurrences.

Evaluating the Persian versions of two psoriatic arthritis screening questionnaires early arthritis for psoriatic patients questionnaire (EARP) and psoriasis epidemiology screening tool (PEST) in Iranian psoriatic patients

Background/aim: The majority of psoriatic arthritis (PsA) patients present at dermatology clinics with cutaneous psoriasis up to 10 years prior to arthritis onset; therefore, applying a suitable screening tool to detect PsA early is essential for dermatologists. This study aimed to validate and evaluate the Persian version of two PsA screening questionnaires, the early arthritis for psoriatic patients questionnaire (EARP) and the psoriasis epidemiology screening tool (PEST) in Iranian psoriatic patients. Materials and methods: In this cross-sectional study, psoriatic patients who presented to the dermatology clinic without a previously established PsA were asked to fill out the Persian version of EARP and PEST. PsA was diagnosed by a rheumatologist based on the fulfillment of the classification criteria for psoriatic arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were calculated for both questionnaires. Results: A total of 75 patients (33 [44%] female, 42 [56%] male, with a mean age of 43.2 ± 14.6) were enrolled in the study. The prevalence of PsA based on rheumatologist diagnosis was 25.3% (19 patients had PsA). The ROC curve analysis of EARP and PEST were 0.949 (95% CI: 0.897­1) and 0.922 (95% CI: 0.834­1). The sensitivity of EARP and PEST questionnaires was 94.7% and 58%, respectively, while the specificity was 78.6% and 96.4%, respectively, with a cut-off of 3. Conclusion: The Persian version of both questionnaires showed good performance. We suggest EARP as a screening tool for PsA in the dermatology clinics due to much higher sensitivity with acceptable specificity compared to PEST.

Developing the Thai Siriraj Psoriatic Arthritis Screening Tool and validating the Thai Psoriasis Epidemiology Screening Tool and the Early Arthritis for Psoriatic Patients questionnaire.

To validate the Thai language version of the Psoriasis Epidemiology Screening Tool (PEST) and the Early Arthritis for Psoriatic Patients Questionnaire (EARP), as well as also to develop a new tool for screening psoriatic arthritis (PsA) among psoriasis (Ps) patients. This was a cross-sectional study. Ps patients visiting the psoriasis clinic at Siriraj Hospital were recruited. They completed the EARP and PEST. Full musculoskeletal history, examination, and radiography were evaluated. PsA was diagnosed by a rheumatologist's evaluation and fulfillment of the classification criteria for psoriatic arthritis. Receiver operator characteristic (ROC) curves, sensitivity, and specificity were used to evaluate the performances of the tools. The Siriraj Psoriatic Arthritis Screening Tool (SiPAT) contained questions most relevant to peripheral arthritis, axial inflammation, and enthesitis, selected from multivariate analysis. Of a total of 159 patients, the prevalence of PsA was 78.6 %. The ROC curve analyses of Thai EARP, PEST, and SiPAT were 0.90 (95 % CI 0.84, 0.96), 0.85 (0.78, 0.92), and 0.89 (0.83, 0.95), respectively. The sensitivities of SiPAT, Thai EARP, and PEST were 91.0, 83.0, and 72.0 %, respectively, while the specificities were 69.0, 79.3, and 89.7 %, respectively. All screening questionnaires showed good diagnostic performances. SiPAT could be considered as a screening tool with its desirable properties: higher sensitivity and taking less time. Thai PEST and EARP could possibly be sequentially administered for people with a positive test from SiPAT to reduce the number of false positives.