A Practical Guide for Assessment of Skin Burden in Patients With Psoriatic Arthritis

Fazira R Kasiem; Annelieke Pasma; Jolanda J Luime; Ilja Tchetverikov; Kim Wervers; Lindy-Anne Korswagen; Natasja Denissen; Yvonne P M Goekoop-Ruiterman; Maikel van Oosterhout; Faouzia Fodili; Johanna M W Hazes; Martijn B A van Doorn; Marc R Kok; Marijn Vis; CICERO

doi:10.3899/jrheum.210550

A Practical Guide for Assessment of Skin Burden in Patients With Psoriatic Arthritis

J Rheumatol. 2022 Oct;49(10):1117-1123. doi: 10.3899/jrheum.210550. Epub 2022 Jun 1.

Affiliations

¹ F.R. Kasiem, MD, A. Pasma, PhD, J.J. Luime, PhD, K. Wervers, MD, PhD, J.M.W. Hazes, MD, PhD, Professor, M. Vis, MD, PhD, Department of Rheumatology, Erasmus Medical Center, Rotterdam; f.kasiem@erasmusmc.nl.
² F.R. Kasiem, MD, A. Pasma, PhD, J.J. Luime, PhD, K. Wervers, MD, PhD, J.M.W. Hazes, MD, PhD, Professor, M. Vis, MD, PhD, Department of Rheumatology, Erasmus Medical Center, Rotterdam.
³ I. Tchetverikov, MD, PhD, Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht.
⁴ L.A. Korswagen, MD, Department of Rheumatology, Franciscus Gasthuis & Vlietland, Rotterdam.
⁵ N. Denissen, MD, Department of Rheumatology, Amphia Hospital, Breda.
⁶ Y.P.M. Goekoop-Ruiterman, MD, PhD, Haga Hospital, Department of Rheumatology, The Hague.
⁷ M. van Oosterhout, MD, Department of Rheumatology, Groene Hart Ziekenhuis, Rotterdam.
⁸ F. Fodili, MD, Department of Rheumatology, Reumazorg Zuid West Nederland, Roosendaal.
⁹ M.B.A. van Doorn, MD, PhD, Department of Dermatology, Erasmus Medical Center, Rotterdam.
¹⁰ M.R. Kok, MD, PhD, Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, the Netherlands.

PMID: 35649550
DOI: 10.3899/jrheum.210550

Abstract

Objective: Rheumatologists play a pivotal role in the management of patients with psoriatic arthritis (PsA). Due to time constraints during clinic visits, the skin may not receive the attention needed for optimal patient outcome. Therefore, the aim of this study was to select a set of core questions that can help rheumatologists in daily rheumatology clinical practice to identify patients with PsA with a high skin burden.

Methods: Baseline data from patients included in the Dutch South West Psoriatic Arthritis (DEPAR) cohort were used. Questions were derived from the Skindex-17 and Dermatology Life Quality Index (DLQI) questionnaires. Underlying clusters of questions were identified with an exploratory principal component analysis (PCA) with varimax rotation, after which a 2-parameter logistic model was fitted per cluster. Questions were selected based on their discrimination and difficulty. Subsequently, 2 flowcharts were made with categories of skin burden severity. Clinical considerations were specified per category.

Results: In total, 413 patients were included. The PCA showed 2 underlying clusters: a psychosocial domain and a domain assessing physical symptoms. We selected these 2 domains. The psychosocial domain contains 3 questions and specifies 4 categories of skin burden severity. The physical symptoms domain contains 2 questions and categorizes patients in 1 out of 3 categories.

Conclusion: We have selected a set with a maximum of 5 questions that rheumatologists can easily implement in their consultation to assess skin burden in patients with PsA. This practical guide makes the assessment of skin burden more accessible to rheumatologists and can aid in clinical decision making.

Keywords: arthritic psoriasis; psoriasis; quality of life.

MeSH terms

Arthritis, Psoriatic* / diagnosis
Dermatology*
Humans
Psoriasis* / diagnosis
Referral and Consultation
Rheumatologists
Rheumatology*
Severity of Illness Index