Comparative Efficacy of Different Triage Methods for Psoriatic Arthritis: Results From a Prospective Study in a Rapid Access Clinic

Abstract

Objective. We undertook this study to identify the optimal combination of triage methods to identify psoriatic arthritis (PsA) among psoriasis patients with musculoskeletal symptoms in a rapid access clinic and to describe their outcome after 1 year.Methods. Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their musculoskeletal symptoms. Each patient was assessed by the following 3 triage modalities: 1) assessment by an advanced practice physical therapist; 2) targeted musculoskeletal ultrasound (MSK-US); and 3) PsA screening questionnaires. The patients were then evaluated by a rheumatologist who determined the patient's disease status and classified them into the following groups: not PsA, possibly PsA, or PsA. Patients returned for a 1-year follow-up visit and were reassessed for change in their disease status. Sensitivity and specificity were calculated for each individual modality, as well as for combinations of modalities.Results. A total of 203 patients with psoriasis and musculoskeletal symptoms were enrolled. The percentage of patients classified as having PsA was 8.8%, and 23.6% were converted into the possibly PsA group. There was no significant difference in the individual performance of the modalities. The highest sensitivity was seen with MSK-US (89%), and the highest specificity was found with the Psoriatic Arthritis Screening and Evaluation questionnaire (79%). The addition of MSK-US data improved the performance of the modalities. A total of 9 patients were classified into the PsA group after 1 year. All patient-reported outcome measures had significantly improved at 1 year (P < 0.001).Conclusion. Combining MSK-US with a screening questionnaire for PsA improved the triage of patients with suspected PsA.

La palabra que articula y nombra

“…El triaje, originalmente fue establecido como un método para gestionar a pacientes producto de situaciones de guerra, que necesitaban atención médica inmediata para salvaguardar su vida (Ameh et al, 2018), es conceptualmente un proceso de clasificación según su estado de salud. Este proceso de valorización inicial categoriza a los pacientes con base a la gravedad de su sintomatología, priorizando así atención médica previo a la evaluación diagnóstica por un especialista en tratamiento (Phiri et al, 2020;Sarabia et al, 2022). Según el sistema de categorización del triaje, los pacientes se dividen en niveles: P1, P2, P3 y P4.…”

Administración eficiente del capital humano y efectividad institucional de los hospitales.

“…El triaje, originalmente fue establecido como un método para gestionar a pacientes producto de situaciones de guerra, que necesitaban atención médica inmediata para salvaguardar su vida (Ameh et al, 2018), es conceptualmente un proceso de clasificación según su estado de salud. Este proceso de valorización inicial categoriza a los pacientes con base a la gravedad de su sintomatología, priorizando así atención médica previo a la evaluación diagnóstica por un especialista en tratamiento (Phiri et al, 2020;Sarabia et al, 2022). Según el sistema de categorización del triaje, los pacientes se dividen en niveles: P1, P2, P3 y P4.…”