No spondyloarthritis screening tools generalizable to all at-risk patients
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Key takeaways:
- Researchers found “substantial variability” in SpA screening tools for use in psoriasis, uveitis and inflammatory bowel disease.
- A generic tool could simplify the referral process for rheumatology assessment.
Screening patients with psoriasis, uveitis or inflammatory bowel disease for spondyloarthritis could improve early diagnosis, but no existing screening tools are generalizable to all who are at risk, according to a scoping review.
“The extra-articular manifestations of SpA may precede the development of articular features by several years and are sometimes the first reason for seeking medical care,” Vartika Kesarwani, MBBS, of the University of Connecticut, and colleagues wrote in Arthritis Care & Research. “Several studies have compared the different PsA screening tools; however, no study has compared the SpA screening tools across the three different patient populations.”
To evaluate the performance of SpA screening tools in patients with uveitis, psoriasis or inflammatory bowel disease, Kesarwani and colleagues conducted a scoping review of 52 studies, including validation studies, comparative analyses, systematic reviews and descriptions of new tools.
From these studies, the researchers identified 13 screening tools for psoriatic arthritis, two for screening SpA in uveitis, and three tools for SpA screening in inflammatory bowel disease. All but one of the tools were patient questionnaires, while the other was an algorithm where physicians could input laboratory and clinical exam data.
According to the researchers, there was “substantial variability” across all tools in terms of how many questions asked about clinical features of SpA, as well as regarding how the questions were phrased. They also noted heterogeneity in the screening tools’ length, scoring methods and cut-off scores. Sensitivities and specificities of the tools across the three patient populations were “broadly comparable,” the researchers wrote.
Based on these findings, Kesarwani and colleagues drafted five lessons for developing future screening tools:
- Questions that are more discriminatory for SpA symptoms may reduce the false positive screening rate.
- Patient evaluation of screening tools in the development phase may improve readability and comprehensibility.
- The use of visual aids may improve agreement between physicians and patients regarding clinical findings, as well as reduce cultural and linguistic barriers.
- Transparent reporting of tool development methodology is critical.
- A clear description of the target population and the context of use is essential in assessing the applicability of the screening tools in clinical practice.
“A generic SpA screening tool may not necessarily perform better than specific tools designed for patients with psoriasis, uveitis, or IBD,” Kesarwani and colleagues wrote. “However, it could present advantages by promoting consistency in screening practices across various clinical settings and simplifying the process of referring patients for rheumatology assessment. The ideal patient-oriented SpA screening tool would screen for the entire clinical spectrum of SpA, include highly discriminatory questions for SpA, and utilize visual aids to improve comprehension and reduce cultural and linguistic barriers.
“Patient involvement during the development of the tool is imperative,” they added. “Screening questions should be easy to understand and require minimal time for completion by the patient before provider engagement. Further, and perhaps most importantly, it is necessary to determine which disease manifestations are most important to the patient and how this can inform not only the purpose of the tool but its performance characteristics.”
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