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Make a PEST of your psoriasis patients


 

EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SEMINAR

All psoriasis patients not already known to have psoriatic arthritis should complete the brief Psoriasis Epidemiology Screening Tool (PEST) for the rheumatologic disease once per year, advised Jashin J. Wu, MD. The PEST is a simple, validated, five-question yes/no screening tool. It’s geared towards nonrheumatologists who may not feel competent to diagnose psoriatic arthritis or who just don’t have time to do so. Three or more “yes” answers is deemed a positive result warranting consideration of referral to a rheumatologist, explained Dr. Wu, the director of the psoriasis clinic and director of dermatology research at Kaiser Permanente Los Angeles Medical Center.

Dr. Jashin J. Wu Bruce Jancin/Frontline Medical News

Dr. Jashin J. Wu

The psoriasis guidelines from the UK National Institute for Health and Care Excellence recommend annual screening using the PEST. The epidemiology of psoriatic arthritis makes this an excellent idea. Up to 30% of psoriasis patients develop psoriatic arthritis, irrespective of the severity of their skin disease, and early treatment is essential to preventing irreversible joint deformity, he said at the Hawaii Dermatology Seminar provided by the Global Academy for Medical Education/Skin Disease Education Foundation.

The five PEST questions are:

  • Have you ever had a swollen joint (or joints)?
  • Has a doctor ever told you that you have arthritis?
  • Do your fingernails or toenails have holes or pits?
  • Have you had pain in your heel?
  • Have you had a finger or toe that was completely swollen and painful for no apparent reason?

The PEST has been shown to have 92% sensitivity and 78% specificity for diagnosis of psoriatic arthritis (Clin Exp Rheumatol. 2009 May-Jun;27[3]:469-74).

Dr. Wu’s call for regular screening for psoriatic arthritis resonated with another psoriasis expert at the meeting, Craig L. Leonardi, MD.

“It’s our moral obligation to be on the lookout for that disease. Remember that patients who develop psoriatic arthritis usually have their skin disease for 10 years before they develop their first signs and symptoms of psoriatic arthritis. So that means they should be in the dermatologist’s office getting their skin treated as they start to have problems with their joints,” observed Dr. Leonardi, of Saint Louis University.

Dr. Wu reported receiving research funding from AbbVie, Amgen, Eli Lilly, Janssen, Novartis, and Regeneron.

The SDEF and this news organization are owned by the same parent company.

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