Early Detection of Psoriatic Arthritis in Dermatology Clinics: Implementing Standardised Musculoskeletal Screening Tools and Brief Physical Examination

ABSTRACT: Background: Psoriatic arthritis (PsA) affects approximately 20–30% of patients with plaque psoriasis, yet the mean diagnostic delay remains 2–3 years from symptom onset. Dermatology clinics represent an ideal setting for opportunistic PsA screening, given that patients are routinely reviewed for cutaneous disease before articular manifestations become apparent. Objective: To evaluate the diagnostic yield of implementing a standardised musculoskeletal questionnaire or brief physical examination screening tool in busy dermatology clinics, as measured by subsequent rheumatologist-confirmed PsA diagnoses. Methods: A systematic narrative review of studies published between January 2020 and December 2024 was conducted across PubMed, EMBASE, and the Cochrane Library, using MeSH terms relating to PsA screening, psoriasis, dermatology, and musculoskeletal assessment tools. Results: Across 14 eligible studies encompassing 3,218 screened patients, implementation of validated tools (PEST, ToPAS-2, EARP, PASE, PURE-4) in dermatology settings identified confirmed PsA in 8.7–14.0% of previously undiagnosed psoriasis patients. Combined questionnaire and brief physical examination approaches achieved the highest sensitivity (up to 92%) and shortened median time to rheumatologist referral by 6–18 months. Conclusion: Integrating a structured two-step approach, a validated patient-reported questionnaire followed by a five-minute targeted musculoskeletal examinationinto routine dermatology practice is feasible, effective, and substantially reduces diagnostic delay in PsA. Interdisciplinary collaboration between dermatologists and rheumatologists is essential for sustainable implementation. Keywords: psoriatic arthritis; early detection; dermatology screening; PEST; musculoskeletal questionnaire; rheumatology referral; diagnostic delay.