What Screening Tools Are Used to Diagnose Psoriatic Arthritis?

Reviewed by: HU Medical Review Board | Last reviewed: October 2016. | Last updated: September 2019

There are multiple questionnaires that are used to screen patients for psoriatic arthritis (PsA). Dermatologists often use these screening tools to determine whether people with psoriasis might be experiencing symptoms of PsA and require a referral to a rheumatologist. However, these screening tools are not diagnostic and do not substitute for a thorough examination by a rheumatologist.1

Psoriatic Arthritis Screening and Evaluation Tool (PASE)

The Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire was developed and validated at the Center for Skin and Related Musculoskeletal Diseases Clinic, a combined dermatology-rheumatology clinic at Brigham and Women’s Hospital in Boston. A multidisciplinary team of dermatologists, rheumatologists, and patient focus groups were involved in the design of PASE. As a screening tool, PASE was designed to help dermatologists identify people with psoriasis who would benefit from a referral to a rheumatologist.1

PASE consists of 15 questions. Seven of the questions assess symptoms, while the other eight assess physical function. Scoring is done numerically, and those with higher scores are more likely to have PsA. In validation, PASE has shown to be effective in distinguishing between PsA and osteoarthritis. PASE can also distinguish between severe PsA and less severe subtypes.1

Toronto Psoriatic Arthritis Screening Tool (ToPAS)

Dr. Dafna Gladman from the Division of Rheumatology at the University of Toronto spearheaded the Toronto Psoriatic Arthritis Screening tool. Dr. Gladman and her team developed and validated ToPAS at five clinical sites in Toronto, including clinics for PsA, psoriasis, general dermatology, general rheumatology, and family medicine. The ToPAS questionnaire is comprised of pictures of psoriatic skin lesions as well as questions about pain and stiffness in the joints and back. ToPAS is also designed to help recognize psoriasis, nail lesions and joint manifestations. ToPAS is considered to be a highly sensitive and specific tool to screen for PsA in psoriasis patients as well as the general population.1,2

Psoriasis Epidemiology Screening Tool (PEST)

The Psoriasis Epidemiology Screening Tool (PEST) was based on earlier assessments with the addition of new questions and a picture of a mannequin for patients to indicate areas of soreness and has been used in Leeds and Bradford in the United Kingdom. PEST has demonstrated sensitivity but less specificity than PASE or ToPAS.1

Early Arthritis for Psoriatic Patients Questionnaire (EARP)

The Early Arthritis for Psoriatic Patients (EARP) questionnaire was developed in a joint dermatology-rheumatology early psoriasis clinic. It was designed to be user friendly and easy to administer. EARP is a rapid screening method for identifying PsA in people with psoriasis and includes 10 questions. EARP has high sensitivity and specificity in identifying PsA.2

Review of assessment tools

Researchers have compared the different assessment tools in clinical trials. One trial evaluated PEST, ToPAS, and the Psoriasis and Arthritis Screening Questionnaire (PASQ) and found that all three were useful screening tools that can help dermatologists identify people without PsA as well as those who may benefit from a rheumatologist assessment. 3 Another study compared PEST, PASE, and ToPAS and found that PEST and ToPAS performed slightly better than PASE at identifying PsA; however, all three tools were validated as effective with little differences seen between them.4

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