Original article
Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics

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Background

Prompt identification and treatment of psoriatic arthritis (PsA) in patients with psoriasis is critical to reducing the risk of joint damage, disability, and comorbidities.

Objective

We sought to estimate PsA prevalence in patients with plaque psoriasis in 34 dermatology centers in 7 European and North American countries.

Methods

Consecutive patients were evaluated by dermatologists for plaque psoriasis and subsequently by rheumatologists for PsA. PsA prevalence was estimated primarily based on rheumatologists' assessment of medical history, physical examination, and laboratory tests.

Results

Of 949 patients evaluated, 285 (30%) had PsA (95% confidence interval 27-33) based on rheumatologists' assessment. PsA diagnosis changed in 1.2% of patients when diagnostic laboratory tests were added to medical history and physical examination. Of 285 patients given the diagnosis of PsA, 117 (41%) had not been previously given the diagnosis.

Limitations

Bias may have been introduced by lack of standardized diagnostic criteria and unbalanced recruitment based on country populations.

Conclusions

In this study, almost a third of patients with psoriasis seen in dermatology centers had PsA as determined by rheumatologists. More than a third of patients with PsA had not been previously given the diagnosis. Clinical evaluation alone is often sufficient basis for PsA diagnosis, but laboratory test results may be helpful in some patients.

Section snippets

Study design/patients

Consecutive patients with plaque psoriasis were enrolled at 34 dermatology centers in 7 European and North American countries (Belgium, Canada, Denmark, France, Germany, Hungary, and the United States) from August 2010 to July 2011. Eligible patients were aged at least 18 years and were initially assessed by a dermatologist for plaque psoriasis regardless of severity. Patients were subsequently evaluated by a rheumatologist, who completed a medical history and physical examination and made a

Patient disposition

Of the 1013 patients enrolled in this study (Table I), 959 had confirmed plaque psoriasis based on the initial dermatologist visit; 959 patients underwent the first rheumatologist assessment (based on medical history and physical examination) and 949 underwent the second rheumatologist assessment (based on medical history, physical examination, and laboratory tests). The following numbers of patients underwent imaging studies: radiographs of hand/wrists and feet/ankles, n = 188 (18.6%);

Discussion

In this large, multinational noninterventional prevalence study, the prevalence of PsA in patients with psoriasis was approximately 30%. Methodological differences among PsA prevalence studies mean that the comparison of findings is a precarious exercise. The 30% estimate reported here appears to be consistent with findings from at least 1 recent, similarly conducted study,16 and falls within the range established by others.15, 17, 18

Of the 285 patients given the diagnosis of PsA by a

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The PREPARE study was sponsored by Pfizer Inc. Editorial/medical writing support was provided by Donna McGuire of UBC Scientific Solutions and was funded by Pfizer Inc.

Disclosure: Dr Mease received grant support and/or honoraria for consultations or speaking engagements from Abbott, Amgen, Biogen Idec, Bristol Myers Squibb, Celgene, Crescendo, Forest, Genentech, Janssen, Lilly, Merck, Novartis, Pfizer Inc, UCB, and Vertex. Dr Gladman received grant support from Abbot, Amgen, Bristol Myers Squibb, Janssen, Pfizer Inc, and UCB. Dr Khraishi received unrestricted educational grants from Pfizer Canada. Dr Thaçi received honoraria for consultations or speaking engagements from Abbott, Amgen, Astellas, Biogen Idec, Celgene, Janssen, Leo, Lilly, MSD, Novartis, and Pfizer Inc. Dr Behrens received grant support and/or honoraria for consultations or speaking engagements from Abbott, Biotest, Chugai, MorphoSys, Pfizer Inc, Roche, and UCB. Dr Northington is an employee of inVentiv Health, paid contractors to Pfizer Inc in providing statistical support for the PREPARE study and the development of this manuscript. Dr Boggs was an employee of Pfizer Inc at the time of study conduct and manuscript development. Ms Fuiman, Dr Bananis, and Dr Alvarez are current employees of Pfizer Inc and owners of Pfizer Inc stock. Dr Papp has no conflicts of interest to declare.

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