New tool uses clinical variables to predict psoriatic arthritis in patients with psoriasis
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Key takeaways:
- A tool predicting psoriatic arthritis risk in patients with psoriasis demonstrated good model performance.
- Factors linked to rapid progression included younger age and use of biologic therapies.
A new tool using readily available clinical variables to predict psoriatic arthritis risk in patients with psoriasis demonstrated reasonable accuracy and good model performance, according to data published in Arthritis & Rheumatology.
“There is an essential need to optimize risk prediction for PsA among patients with psoriasis, which should improve care delivery for high-risk patients,” Lihi Eder, MD, PhD, of the Women’s College Research Institute and the University of Toronto, and colleagues wrote. “However, no such prediction tool currently exists. A simple, scalable tool that identifies patients with psoriasis who are at high risk for developing PsA will be an important step towards improving early detection enabling opportunities for early interventions, which may halt progression from psoriasis to PsA.”
To create a risk prediction tool for PsA progression in patients with psoriasis, Eder and colleagues used data from the University of Toronto Psoriasis Cohort, which features patients with psoriasis, but not PsA, at enrollment. The researchers included 29 variables that could act as potential predictors in the algorithm. These included age, sex, morning joint stiffness, back pain, BMI, psoriasis body scores and family history of psoriasis, PsA and other arthritic diseases.
The researchers followed a total of 635 patients with psoriasis who were examined by a rheumatologist to rule out any inflammatory conditions prior to enrollment. The patients provided information on lifestyle habits, family medical history, any present musculoskeletal symptoms, present comorbidities and prescribed medications. Patients underwent annual examinations by a rheumatologist who evaluated the presence or lack of PsA.
According to the researchers, 51 of the included patients developed PsA in 1 year, while 71 developed the disease within 5 years. Risk factors linked to developing the disease in 1 year included younger age at disease onset, male sex, a family history of psoriasis and the use of biologic therapies. Risk factors linked to development within 5 years included morning stiffness, psoriatic nail lesions, psoriasis severity, fatigue, pain and the use of non-biologic therapies.
Regarding the prediction tool, dubbed the Psoriatic Arthritis Risk Estimation Tool, or PRESTO, the researchers determined there was “reasonable agreement” between the predicted and observed probability of outcomes.
“We derived and internally validated a novel risk prediction tool for PsA in patients with psoriasis,” Eder and colleagues wrote. “PRESTO has good model performance and can provide estimated risk of developing PsA within shorter and longer time periods that are relevant for both clinical and research purposes. If further validated, we anticipate that PRESTO may facilitate efforts to improve early detection of at-risk populations enabling opportunities for early interventions that may halt progression to PsA.”
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