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Objective. To describe the range and depth of perspectives and experiences of patients with psoriasis and psoriatic arthritis to inform gaps in patient-centered care.Methods. We searched MEDLINE, Embase, PsycINFO, and CINAHL to April 2018. Thematic synthesis was used to analyze the findings.Results. We included 56 studies involving 1,484 adult patients with psoriasis (n = 1,147) and psoriatic arthritis (n = 337). Six themes (and subthemes) were identified: suffering uncontrollable and ongoing upheaval (dictating life choices and course, disrupting family and social roles, limited by debilitating symptoms, unstoppable and far-reaching fatigue), weighed down by mental load (anxiety provoked by the volatility of symptoms, dreading deterioration, struggling with unrecognized distress, helpless and nihilistic), harboring shame and judgement (marked as unhygienic and contagious, rejected and isolated, hiding away and resenting own appearance, pain and embarrassment in intimacy), demoralized by inadequacies and burden of therapy (disappointed by unmet expectations of treatment benefit, daily drudgery, deterred by unpalatable or inconvenient treatments, disempowered by lack of personalized care), gaining control (making sense of the condition, accepting a new health status, regaining independence and normality, attuning to the body), and making confident treatment decisions (trading off perceptible benefits against safety and convenience, relying on family input, seeking empowering and reassuring relationships).Conclusion. Patients with psoriasis and psoriatic arthritis contend with disruption in their functioning, roles, and life course and have unmet expectations about treatment. Enhanced therapeutic relationships, addressing treatment expectations and supporting psychosocial needs may improve satisfaction and outcomes.

Aim A treat‐to‐target strategy is recommended for management of psoriatic arthritis (PsA), although there is lack of agreement regarding the best measure of disease activity to target. Physician assessments included in traditional indices can be complex and time consuming to complete and cannot be readily conducted by telehealth. This study compares the routine assessment of patient index data 3 (RAPID3), an efficient tool comprising patient self‐assessment, with traditional clinician‐led composite measures in the PsA clinic setting. Methods Data were collected prospectively from July 2016 to March 2020 in 2 dedicated PsA clinics in Sydney, Australia. A receiver operating characteristic (ROC) curve was created for comparison of RAPID3 score with composite scores minimal disease activity (MDA), very low disease activity (VLDA) and disease activity in psoriatic arthritis (DAPSA) in low disease activity or remission. Results Ninety‐three patients had simultaneous collection of RAPID3 and MDA measures. Mean (SD) age was 49.9 (13.5) years, 50.5% were male and 23 (24.7%) had erosive disease at baseline. RAPID3 scores ≤3.2 and ≤2.7 (range 0‐30) had high sensitivity and specificity for VLDA and DAPSA remission respectively, with ROC curve area under the curve (95% CI) of 0.94 (0.91‐0.97) and 0.96 (0.93‐0.99). Conclusion RAPID3 has good agreement with physician‐led composite scores of MDA, VLDA and DAPSA, and provides a viable alternative to composite scores. This is particularly helpful in settings that do not allow for clinical examination, for example telehealth.

BackgroundStudies suggest a high prevalence (approximately 15%) of undetected psoriatic arthritis (PsA) amongst patients with psoriasis1. A number of screening questionnaires have been designed to allow detection of such patients. This includes the Early Psoriatic Arthritis Screening Questionnaire (EARP) which detects early PsA in untreated patients with psoriasis, with a sensitivity of 85.2% and specificity of 91.6%2. Little is known about whether such questionnaires are also able to detect PsA in treated patients with psoriasis.ObjectivesTo determine the case finding ability of EARP in a tertiary centre cohort of treated psoriasis patients.MethodsAll patients attending a tertiary centre psoriasis clinic were invited to complete the EARP. EARP comprises a 10 point patient reported questionnaire regarding symptoms of joint disease. Scores of 3 or more are considered positive. All patients who completed the questionnaire and received a positive score were assessed by a rheumatologist. Diagnosis of PsA was made by clinician impression and CASPAR criteria. Disease activity was assessed using psoriasis area severity index (PASI), 66/68 swollen and tender joint count, SPARCC enthesitis index, CRP and Health associated quality of life disability index (HAQ-DI). The composite disease activity measure DAPSA and the OMERACT definition of minimal disease activity were determined.Results133 patients were invited to complete the EARP questionnaire and 119 participated. Fifty patients had a positive result (42%). Of these, 8 were known to have PsA and under rheumatologic care. A further 21 attended for formal rheumatologic assessment. Thirteen of the 21 patients (61.9%) were found to have psoriatic arthritis and were not under the care of a rheumatologist. This represents 10% of the initial 133 patients screened. Ten of those patients were further assessed. The average age was 52.8 and BMI 33.2. Seven patients were male. All 10 were on biologic agents but only 3 on concurrent conventional DMARDs. Average tender joint count was 16, swollen joint count 3.6, SPARCC 6.2 and PASI score 3.42. Only 1 patient was in minimal disease activity.ConclusionsThe EARP tool can identify patients with active PsA amongst patients with psoriasis, even those on treatment with biologic agents. Such a tool may be useful in identifying patients who may benefit from rheumatology care.References[1] Villani AP, Rouzaud M, et al. Prevalence of undiagnosed psoriatic arthritis among psoriasis patients: Systematic review and meta-analysis.J Am Acad Dermatol2015;73(2):242–8.[2] Tinazzi I, Adami S, Zanolin EM, et al. The early psoriatic arthritis screening questionnaire: a simple and fast method for the identification of arthritis in patients with psoriasis. Rheumatology2012;51(11):2058–63.Disclosure of InterestNone declared