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Patients with psoriasis may have undiagnosed psoriatic arthritis

More than 15% of patients with psoriasis had undiagnosed psoriatic arthritis, according to a literature review and meta-analysis of studies.

Researchers searched PubMed, Cochrane and Embase databases for studies indexed between January 1980 and February 2013, using the search terms “arthritis, psoriatic/epidemiology” and “prevalence,” which yielded 394 potentially relevant studies. None of the studies focused on determining undiagnosed psoriatic arthritis in patients with psoriasis. The researchers estimated undiagnosed psoriatic arthritis by using the prevalence of newly diagnosed psoriatic arthritis in patients with psoriasis when they seek medical care.

Twelve studies, including five studies gathered from an additional literature search on psoriatic arthritis screening questionnaires, were included in the final review. Patients presented to a dermatologist first in seven studies, while suspected arthritis was not mentioned as a reason. Final diagnosis of psoriatic arthritis was made by a senior rheumatologist in seven studies, while it was not mentioned who was responsible for the diagnosis in the other five studies.

There was a variance of 4.2% to 33.6% in the point prevalence of undiagnosed psoriatic arthritis. The point prevalence of psoriatic arthritis based on meta-analysis was 15.5% (95% CI, 11.5%-19.5%) in all studies and 10.1% (95% CI, 6.1%-14.1%) when the studies based on the psoriatic arthritis screening questionnaires were excluded. High heterogeneity caused most of the variability in the studies (I² = 96.86), the researchers said.

“Not all patients with arthritis experience an arthritic flare or active enthesitis at the time they are seen by a dermatologist,” the researchers concluded. “However, early detection of [psoriatic arthritis] is essential because tight control of inflammation in these patients may improve joint outcome. Dermatologists should therefore be able to determine whether a patient with psoriasis requires prompt referral to a rheumatologist.” – by Bruce Thiel

Disclosure: The researchers report receiving consultant fees from AbbVie, which provided financial support for the study publication.