Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics

Published:August 26, 2013DOI:


      Prompt identification and treatment of psoriatic arthritis (PsA) in patients with psoriasis is critical to reducing the risk of joint damage, disability, and comorbidities.


      We sought to estimate PsA prevalence in patients with plaque psoriasis in 34 dermatology centers in 7 European and North American countries.


      Consecutive patients were evaluated by dermatologists for plaque psoriasis and subsequently by rheumatologists for PsA. PsA prevalence was estimated primarily based on rheumatologists' assessment of medical history, physical examination, and laboratory tests.


      Of 949 patients evaluated, 285 (30%) had PsA (95% confidence interval 27-33) based on rheumatologists' assessment. PsA diagnosis changed in 1.2% of patients when diagnostic laboratory tests were added to medical history and physical examination. Of 285 patients given the diagnosis of PsA, 117 (41%) had not been previously given the diagnosis.


      Bias may have been introduced by lack of standardized diagnostic criteria and unbalanced recruitment based on country populations.


      In this study, almost a third of patients with psoriasis seen in dermatology centers had PsA as determined by rheumatologists. More than a third of patients with PsA had not been previously given the diagnosis. Clinical evaluation alone is often sufficient basis for PsA diagnosis, but laboratory test results may be helpful in some patients.

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        • Husted J.A.
        • Gladman D.D.
        • Farewell V.T.
        • Cook R.J.
        Health-related quality of life of patients with psoriatic arthritis: a comparison with patients with rheumatoid arthritis.
        Arthritis Rheum. 2001; 45: 151-158
        • Krueger G.
        • Koo J.
        • Lebwohl M.
        • Menter A.
        • Stern R.S.
        • Rolstad T.
        The impact of psoriasis on quality of life: results of a 1998 National Psoriasis Foundation patient-membership survey.
        Arch Dermatol. 2001; 137: 280-284
        • Taylor W.J.
        • Mease P.J.
        • Adebajo A.
        • Nash P.J.
        • Feletar M.
        • Gladman D.D.
        Effect of psoriatic arthritis according to the affected categories of the international classification of functioning, disability and health.
        J Rheumatol. 2010; 37: 1885-1891
        • Tillett W.
        • de-Vries C.
        • McHugh N.J.
        Work disability in psoriatic arthritis: a systematic review.
        Rheumatology (Oxford). 2012; 51: 275-283
        • Gladman D.D.
        • Antoni C.
        • Mease P.
        • Clegg D.O.
        • Nash P.
        Psoriatic arthritis: epidemiology, clinical features, course.
        outcome. Ann Rheum Dis. 2005; 64 (ii14-7)
        • Rahman P.
        • Nguyen E.
        • Cheung C.
        • Schentag C.T.
        • Gladman D.D.
        Comparison of radiological severity in psoriatic arthritis and rheumatoid arthritis.
        J Rheumatol. 2001; 28: 1041-1044
        • Wong K.
        • Gladman D.D.
        • Husted J.
        • Long J.A.
        • Farewell V.T.
        Mortality studies in psoriatic arthritis; results from a single outpatient clinic, I: causes and risk of death.
        Arthritis Rheum. 1997; 40: 1868-1872
        • Gladman D.D.
        • Farewell V.T.
        • Wong K.
        • Husted J.
        Mortality studies in psoriatic arthritis; results from a single outpatient center, II: prognostic indicators for death.
        Arthritis Rheum. 1998; 41: 1103-1110
      1. Chin YY, Yu HS, Li WC, Ko YC, Chen GS, Wu CS, et al. Arthritis as an important determinant for psoriatic patients to develop severe vascular events in Taiwan: a nationwide study. J Eur Acad Dermatol Venereol doi: Published online September 25, 2012.

        • Gladman D.D.
        Psoriatic arthritis from Wright's era until today.
        J Rheumatol. 2009; 36: 4-8
        • Elkayam O.
        • Ophir J.
        • Yaron M.
        • Caspi D.
        Psoriatic arthritis: interrelationships between skin and joint manifestations related to onset, course and distribution.
        Clin Rheumatol. 2000; 19: 301-305
        • Gelfand J.M.
        • Gladman D.D.
        • Mease P.J.
        • Smith N.
        • Margolis D.J.
        • Nijsten T.
        • et al.
        Epidemiology of psoriatic arthritis in the population of the United States.
        J Am Acad Dermatol. 2005; 53: 573
        • Gottlieb A.B.
        • Mease P.J.
        • Mark Jackson J.
        • Eisen D.
        • Amy Xia H.
        • Asare C.
        • et al.
        Clinical characteristics of psoriatic arthritis and psoriasis in dermatologists' offices.
        J Dermatolog Treat. 2006; 17: 279-287
        • Eder L.
        • Chandran V.
        • Shen H.
        • Cook R.J.
        • Shanmugarajah S.
        • Rosen C.F.
        • et al.
        Incidence of arthritis in a prospective cohort of psoriasis patients.
        Arthritis Care Res (Hoboken). 2011; 63: 619-622
        • Christophers E.
        • Barker J.N.
        • Griffiths C.E.
        • Dauden E.
        • Milligan G.
        • Molta C.
        • et al.
        The risk of psoriatic arthritis remains constant following initial diagnosis of psoriasis among patients seen in European dermatology clinics.
        J Eur Acad Dermatol Venereol. 2010; 24: 548-554
        • Haroon M.
        • Kirby B.
        • Fitzgerald O.
        High prevalence of psoriatic arthritis in patients with severe psoriasis with suboptimal performance of screening questionnaires.
        Ann Rheum Dis. 2013; 72: 736-740
        • Reich K.
        • Kruger K.
        • Mossner R.
        • Augustin M.
        Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis.
        Br J Dermatol. 2009; 160: 1040-1047
        • Khraishi M.
        • Chouela E.
        • Bejar M.
        • Landells I.
        • Hewhook T.
        • Rampakakis E.
        • et al.
        High prevalence of psoriatic arthritis in a cohort of patients with psoriasis seen in a dermatology practice.
        J Cutan Med Surg. 2012; 16: 122-127
        • Khraishi M.
        • Landells I.
        • Mugford G.
        The self-administered Psoriasis and Arthritis Screening Questionnaire (PASQ): a sensitive and specific tool for the diagnosis of early and established psoriatic arthritis.
        Psoriasis Forum. 2010; 16: 9-16
        • Ibrahim G.H.
        • Buch M.H.
        • Lawson C.
        • Waxman R.
        • Helliwell P.S.
        Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: the Psoriasis Epidemiology Screening Tool (PEST) questionnaire.
        Clin Exp Rheumatol. 2009; 27: 469-474
        • Gladman D.D.
        • Schentag C.T.
        • Tom B.D.
        • Chandran V.
        • Brockbank J.
        • Rosen C.
        • et al.
        Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS).
        Ann Rheum Dis. 2009; 68: 497-501