AB0940 Health services research project for the early diagnosis of psoriatic arthritis: monocentric questionnaire-based study to identify patients with arthritis and detect signs of depression in 150 patients
Authors: N. Frede, F. Schauer, C. Schempp, S. Finzel, F. Röther, R. Voll, J. Thiel, N. Venhoff
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Psoriatic arthritis (PsA) is an inflammatory rheumatic disease affecting approximately 30% of psoriasis (PsO) patients. Despite increased awareness there is still a considerable delay in diagnosis. Untreated PsA may lead to irreversible joint destruction associated with a high rate of disability and depression. A timely diagnosis and initiation of treatment are therefore essential. <h3>Objectives</h3> In order to minimise diagnostic delay and improve patient care, we have implemented a questionnaire-based screening procedure in the dermatology outpatient clinic to identify patients with suspected PsA. <h3>Methods</h3> A questionnaire-based screening (PEST, FFbH, WHOQOL-BREF, Phq9, GHQ-12) was used to assess PsO patients for PsA, depression, comorbidities, and quality of life (QOL). <h3>Results</h3> So far we have assessed 150 PsO patients. 79% reported joint affection with a mean number of 4.58 involved joint regions, predominantly at the lower extremities. 34% described axial involvement. 42% had a score of ≥3 in the PEST tool, being suspicious for PsA. 4% had a clinically relevant functional impairment in daily life assessed by FFbH questionnaire (score &lt;60%). In WHOQOL-BREF PsO patients scored lower on the physical health as well as the psychological wellbeing scale when compared to reference values for healthy controls, while results in the social relationship and environment domains were comparable. When comparing patients with suspected PsA to PsO without arthritis the former group reached significantly lower scores in the physical health domain (p=0.0001), in the psychological wellbeing (p=0.0434), and environment domains (p=0.0384), especially regarding items assessing body image/appearance and negative feelings for psychological wellbeing as well as physical security and mobility/transport in the environment domain. For the social domain there were no differences. In the Phq9 questionnaire patients reached a mean of 6.5 points equalling mild depressive symptoms. 16% of PsO patients had moderate depressive symptoms, while 9% had severe depressive symptoms. In patients with suspected PsA 44% had moderate (26%) or severe (18%) depression compared to 7% and 2% respectively in PsO patients without arthritis. <h3>Conclusions</h3> Screening questionnaires are valuable tools for dermatologists as well as general practitioners and help to identify PsO patients with musculoskeletal involvement pointing towards psoriatic arthritis. Thus, screening questionnaires can add to ensure timely referral of patients with inflammatory joint involvement and depression to the corresponding specialists and help to avoid a delay of treatment. Our data confirm an association of psoriasis, depressive symptoms and reduced quality of life, which was even stronger in patients with psoriatic arthritis. <h3>Disclosure of Interest</h3> None declared