Home screening surveys may improve rheumatology referral for PsA diagnosis
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PHILADELPHIA — While over half of referrals generated by results from a home-screening survey for psoriatic arthritis were deemed appropriate, the rate of an actual diagnosis was low, according to results of a study.
The findings from the sub-analysis were presented at ACR Convergence 2022.
“This study is a continuation of our prior study,” Megan Meier, MD, a fellow at the University of Utah, said during the presentation. “We previously showed that patients with psoriasis were more frequently evaluated by a rheumatologist if they assessed their own risk of developing psoriatic arthritis with a home screening survey and then contacted staff directly to make a rheumatology appointment. We wanted to see what came with those initial rheumatology appointments.”
Patients with psoriasis were identified from electronic health records within the University of Utah and VA Medical Center health care systems. From the EHR, researchers pulled patient characteristics, clinical findings, and diagnostic outcomes. The rheumatology referral was deemed appropriate if the patient had a history of confirmed or probable psoriasis, no previous encounters with a rheumatologist within the last 6 years and received a new diagnosis of PsA during the appointment, or they had symptoms, exam findings or test results that resulted in subsequent workups and appointments.
According to the poster, 1,413 patients completed the Psoriasis Epidemiology Screening Tool Survey1, of which 27 had an appointment with a rheumatologist. Those seen by a rheumatologist had a mean age of 61.5 years, 66% were male, and 14.8% had a previous encounter with a rheumatologist, although it was non-diagnostic for PsA at the time.
A dermatologist or primary care provider verified psoriasis history for 59.2% of patients, and, at 33%, the most common clinical finding was enthesitis of the Achilles, plantar fascia insertions or epicondyles.
The researchers reported a PsA diagnosis for 4.7% of patients, with an extra 6.7% who were diagnosed with possible PsA or another inflammatory joint disease. In 63% of patients, the rheumatology referral was deemed appropriate.
“When patients completed a home screening survey and they themselves made a rheumatology appointment that they were high risk, over half of those self-referrals were deemed appropriate,” Meier said. “The rate of psoriatic arthritis diagnosis was low, but there certainly is a high impact for those who received a diagnosis.”
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Meier MI, et al. Abstract 0401. Presented at: ACR Convergence 2022; November 11-14, 2022; Philadelphia (hybrid meeting).
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