UMMS Affiliation

Division of Preventive and Behavioral Medicine

Publication Date


Document Type



Dermatology | Diagnosis | Epidemiology | Musculoskeletal Diseases | Skin and Connective Tissue Diseases


BACKGROUND: Despite increasing awareness of the disease, rates of undiagnosed psoriatic arthritis (PsA) are high in patients with psoriasis (PsO). The validated Psoriasis Epidemiology Screening Tool (PEST) is a five-item questionnaire developed to help identify PsA at an early stage.

OBJECTIVES: To assess the risk of possible undiagnosed PsA among patients with PsO and characterize patients based on PEST scores.

METHODS: This study included all patients enrolled in the Corrona PsO Registry with data on all five PEST questions. Demographics, clinical characteristics and patient-reported outcomes were compared in Corrona PsO Registry patients with PEST scores > /=3 and < 3 using t-tests for continuous variables and chi-squared tests for categorical variables; scores > /=3 may indicate PsA.

RESULTS: Of 1516 patients with PsO, 904 did not have dermatologist-reported PsA; 112 of these 904 patients (12.4%) scored > /=3 and were significantly older, female, less likely to be working, and had higher BMI than patients with scores < 3. They also had significantly longer PsO duration, were more likely to have nail PsO and had worse health status, pain, fatigue, Dermatology Life Quality Index and activity impairment.

CONCLUSIONS: Improved PsA screening is needed in patients with PsO because the validated PEST identified over one-tenth of registry patients who were not noted to have PsA as having scores > /=3, who could have had undiagnosed PsA. Appropriate, earlier care is important because these patients were more likely to have nail PsO, worse health-related quality of life and worse activity impairment.

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© 2019 The Authors. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

DOI of Published Version



J Eur Acad Dermatol Venereol. 2019 May;33(5):886-892. doi: 10.1111/jdv.15443. Epub 2019 Mar 5. Link to article on publisher's site

Journal/Book/Conference Title

Journal of the European Academy of Dermatology and Venereology : JEADV

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Creative Commons License

Creative Commons Attribution-Noncommercial 4.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License