Artikel
Combination of questionnaires for diagnosis of Psoriatic Arthritis and fluorescence-optical imaging technique in daily routine care: Enrichment of sensitivity for detection of subclinical signs of musculoskeletal inflammation in Psoriasis?
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Autoren
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Michaela Köhm
- Abteilung Rheumatologie, Universitätsklinikum Frankfurt & Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
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Tanja Rossmanith
- Klinische Forschung, Fraunhofer IME, Projektgruppe Translationale Medizin und Pharmakologie (TMP), Frankfurt am Main, Frankfurt am Main
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Hans-Eckhard Langer
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf, Düsseldorf
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Gerd-Rüdiger Burmester
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
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Benjamin Köhler
- Evangelisches Fachkrankenhaus, Rheumatologische Klinik, Ratingen
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Ulrich Käßer
- Schwerpunktpraxis für Rheumatologie am Krankenhaus Balserische Stiftung, Rheumatologie, Gießen
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Marina Backhaus
- Park-Klinik Weissensee, Abteilung für Innere Medizin - Rheumatologie und Klinische Immunologie, Berlin
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Harald Louis Burkhardt
- Klinikum der Johann Wolfgang Goethe-Universität, Medizinische Klinik II, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
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Frank Behrens
- CIRI am Klinikum der Johann Wolfgang Goethe-Universität, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
| Veröffentlicht: | 29. August 2016 |
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Gliederung
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Background: Psoriasis (Pso) is one of the most common chronic inflammatory skin diseases in Europe. Psoriatic arthritis (PsA) is closely associated to Pso and appears in up to 30% of Pso patients; the skin manifestation appears usually years before PsA. Questionnaires for detection of PsA (PASE, PEST, GEPARD) are validated tools for usage in dermatology practice. Fluorescence-optical imaging technique is a method to detect changes in microvascularisation of the hands as potential marker for musculoskeletal inflammation. The combination of both might enrich the diagnostic value to detect subclinical disease activity of PsA.
Methods: This interims analysis includes 151 Pso patients (diagnosis confirmed by dermatologist) without pre-existing diagnosis of PsA but risk factors for its development (nail psoriasis and/or joint pain or swelling within the last 6 months) from a prospective, multicentre study (XCITING) in Germany. Patients are examined by rheumatologist (clinical examination and ultrasound) to determine PsA-diagnosis. FOI is performed additionally and analysed by an independent central reader. Results for PASE, PEST and GEPARD as well as for FOI in comparison to the diagnosis of PsA are compared to survey their discriminating value.
Results: In 53.6% of the Pso-patients with risk of development of PsA, PsA was diagnosed by rheumatologist. Of those patients, 71.6% were positive by PASE, 32.1% by PEST and 44.4% by GEPARD.PsA risk was detected in 67.9% by PASE, 28.4% by PEST and 55.6% by GEPARD although rheumatologic examination was negative.In addition to positive PsA-diagnosis by rheumatologists, in 23.2% of Pso patients without clinical verified PsA a positive FOI-signal could be detected. In this group PASE was positive in 47.1%, PEST in 14.3% and GEPARD in 25.7% of the patients.
Conclusion: In this cohort of patients with active Pso with pre-defined risk of development of PsA, more than 50% of the patients were classified as PsA by rheumatologist. The sensitivity of detection of PsA by using questionnaires in early disease seems to be limited. A benefit of addition of both, questionnaires and FOI for detection of subclinical PsA is debatable.
