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August 23, 2022
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PEST score, BMI help predict psoriatic arthritis development in patients with psoriasis

Fact checked byKristen Dowd
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For patients with psoriasis, tools such as the Psoriasis Epidemiology Screening Tool can help predict the possibility of future psoriatic arthritis development, according to a study.

It is estimated that 20% to 30% of patients with psoriasis will develop psoriatic arthritis (PsA) at some point, and early identification is necessary for improved outcomes.

Psoriatic arthritis 1
For patients with psoriasis, tools such as the Psoriasis Epidemiology Screening Tool can help predict the possibility of future psoriatic arthritis development.

“Previous studies have not examined the predictive validity but rather the association between having a positive [Psoriasis Epidemiology Screening Tool (PEST)] score and having psoriatic arthritis at a single time point,” Alexis Ogdie, MD, MSCE, of the Perelman School of Medicine at the University of Pennsylvania and the study’s lead author, told Healio.

Alexis Ogdie

Using the prospective, multicenter, noninterventional CorEvitas Psoriasis Registry, researchers conducted a prospective cohort study of 1,489 patients with psoriasis who did not have PsA at enrollment.

Nine logistic regression models, both unregularized and regularized, were developed to predict PsA at 24 months.

Of 1,042 patients selected to be in the training data set, 119 (11.4%) had PsA at the 24-month follow-up, while 923 (88.6%) did not. For the remaining 447 patients who were included in the testing data set, 9.2% had PsA at 24 months.

The best performing predictive model was the use of PEST, in conjunction with BMI, modified Rheumatic Disease Comorbidity Index, work status, alcohol use and patient-reported fatigue. A second model with just PEST and BMI had similar results.

“This is still at the research stage; however, it suggests that the PEST tool may not only be helpful for screening which patients with psoriasis to send to the rheumatologist, but may also have some predictive validity over time,” Ogdie said. “If you combine a positive PEST score plus obesity, the patient's likelihood of developing PsA is higher. Eventually we may be able to refine these scores even more to consider how to detect patients at highest risk.”

With many patients with PsA remaining undiagnosed, leading to delays in treatment, these screening tools can be helpful to improve outcomes. The authors suggest patients with psoriasis who are undergoing treatment to be evaluated using PEST and BMI factors to predict future PsA.