P57 Cross-sectional application of the dermatologist-centred screening tool, looking for axial psoriatic arthritis in patients with severe plaque psoriasis

Abstract Psoriasis is a chronic, inflammatory and immune-mediated systemic disease that primarily affects the skin and joints. In ∼70% of cases, the skin disease precedes joint involvement, and it is estimated that approximately one-third of patients with psoriatic disease will develop psoriatic arthritis (PsA) over the course of their disease. Researchers often seek to establish good screening tools or even biomarkers that can help the clinical dermatologist in this assessment, improving the window of opportunity for action. Most of the validated tools, such as PEST and PASE, despite their excellent performance, do not consider the axial domain of PsA. We conducted a cross-sectional study on our cohort of severe psoriasis patients from our outpatient clinic, applying the dermatologist-centred screening (DCS) questionnaire. PsA was defined by CASPAR criteria. Statistical analysis was performed in SPSS 20.0. The study underwent ethical review and was approved: average age of 50.84 years, with a slight predominance of females (53.2%). The average duration of the disease was 15.89 years. Mean PASI and body surface area (BSA) were, respectively, 16.65 and 20.88%. Hundred and fifty-eight patients were studied: average age of 50.84 years, with a slight predominance of females (53.2%). The average duration of the disease was 15.89 years. Mean PASI and BSA were, respectively, 16.65 and 20.88%. Fifty of the 158 patients were diagnosed with PsA (31.6%). In the sample, 35 patients had positive DCS. Of these 35, in fact, 25 (71.4%) had PsA. Having positive DCS implies a prevalence at least three times higher than having PsA (prevalence ratio: 3.254, P < 0.0001, 95% confidence interval = 2.195–4.824). Among the 25 with positive DCS, 10 patients had low back pain at the end of the night, sometimes even being woken up by the pain; maintaining it during the morning, associated with stiffness for at least 30 min; in addition to relief with movement and stretching. Of these 10, 7 (14% of patients with PsA and 28% of all with positive DCS) had a confirmed diagnosis of axial PsA, supported by evaluation by a board-certified rheumatologist, in addition to complementary exams (all with positive magnetic resonance imaging showing sacroiliitis). The ATTRACT study studied 365 patients; selecting through DCS 124. Of these, 36 (29%) confirmed a diagnosis of Axial PsA and 21 (16.9%) had peripheral PsA, without axial involvement. DCS appears to be a practical, quick and easy tool to perform in clinical practice, correctly selecting patients for better evaluation by a rheumatologist, probably contributing to a better diagnosis. The limitations of this work are the cross-sectional design and small sample.