A study of 300 patients with psoriatic arthritis found that individuals can accurately self-report non-musculoskeletal symptoms such as dactylitis, skin and nail psoriasis, and uveitis. The findings support the use of patient-reported outcome measures in routine clinical care.
Researchers tested patient-reported outcome measures (PROMs) added to a nationwide rheumatology registry. A sample of 300 patients answered yes/no questions about specific symptoms, including the presence and number of sausage-like swollen digits (dactylitis), skin and nail changes, and recent episodes of painful red eyes (uveitis).
For skin psoriasis, patient reports matched physician assessments with a sensitivity of 1.00, specificity of 0.94, and Cohen’s kappa of 0.95. For nail psoriasis, the PROM had a sensitivity of 0.76, specificity of 0.94, and kappa of 0.66.
Dactylitis was initially more difficult for patients to identify. Among the first 134 participants, 20% misreported the condition. After a clinical photo was added to the PROM, sensitivity improved from 0.75 to 0.88, and specificity from 0.79 to 0.83. Agreement (kappa) increased from 0.30 to 0.57. Patients tended to slightly overreport; the average difference between patient- and physician-reported digit counts decreased from 1.0 to 0.7 after the photo was added.
Only 3 patients (1.00%) reported uveitis since their last visit. Patient self-reports aligned with physician records, showing sensitivity of 1.00, specificity of 0.99, and kappa of 0.59.
Author Louise Majormoen Nielung of the Centre for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, emphasized the value of these tools in daily practice: “Patients with PsA reliably self-report dactylitis, psoriasis, and uveitis and the PROMs are valuable for monitoring non-musculoskeletal manifestations in routine care.”
The median patient age was 55 years, and 153 (51.0%) were female. Median disease duration was 8 years. A total of 129 patients (43.0%) were treated with conventional synthetic DMARDs, 130 (43.3%) with biologic or targeted synthetic DMARDs, and 41 (13.7%) received no DMARD therapy.
Based on DAPSA28 scores, 25.0% of patients were in remission, 25.0% had low disease activity, 13.7% moderate, and 6.7% high.
Physicians were blinded to patient responses in the final 100 participants to test for bias. After blinding, dactylitis sensitivity remained at 0.89, and specificity was 0.81.
PROM performance varied by disease duration. Among patients with psoriatic arthritis for over two years, dactylitis sensitivity was 0.84, compared with 0.60 in those with shorter disease duration. Fewer long-duration patients responded “do not know” (8% vs 17%).
The study showed that PROMs can detect key disease features outside the joints with good accuracy. These tools may support treatment planning and reduce clinical workload when used alongside physical examination.
Full disclosures can be found in the published study.
Source: RMD Open