Psoriatic arthritis: a tool for earlier diagnosis

Did a doctor diagnose you with psoriasis? Do you have lesions? Any tender joints? Swollen digits? Morning stiffness? Back pain with tightness?

Answers to questions like these help raise the red flag for psoriatic arthritis. At the Toronto Western Research Institute, Dr. Dafna Gladmanand her team are developing a screening questionnaire that helps busy doctors quickly spot warning signs for the disease – and get their patients to a rheumatologist or dermatologist as quickly as possible.

It is called the “Toronto Psoriatic Arthritis Screen” and was recentlypublished in the Journal of Rheumatology. Dr. Gladman is in year 3 of a strategic operating grant from The Arthritis Society in a bid to help Canadians with psoriatic arthritis get earlier diagnoses. Version 2 of this screening tool will be ready for wide use within the year.

An early diagnosis is imperative, Dr. Gladman explains: two studies this decade clearly show that people who are diagnosed later have more damage in their body and poorer outcomes. One suggested that if you can be diagnosed within six months of symptoms appearing, there were much better outcomes. Each additional six months meant a person was progressively worse off.

“That’s the reason we are intent on getting early diagnosis and early treatment,” she says. “And why the screening questionnaire is so important.”

People with psoriatic arthritis often begin with psoriasis, a skin condition diagnosed by family physicians and dermatologists. Getting an accurate screening tool in the hands of these professionals would greatly accelerate the process of identifying psoriatic arthritis in a timely fashion.

Groups around the world have aimed to create a solid, functional screening tool. In many cases, the instrument worked well during development, but didn’t work so well when put into practice.

Dr. Gladman’s tool seeks to change that, and has the potential to be the world’s most highly sensitive and specific tool to identify patients with psoriatic arthritis – whether or not they have psoriasis. It was recently tested by a Turkish group who also found it highly sensitive and specific.

“I think we are pretty close to having an electronic version which will be available to physicians and patients,” she says.


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