Psoriatic Arthritis Screening and Evaluation (PASE) questionnaire and the role of dermatologists: a report from the GRAPPA 2009 annual meeting.

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, often with a variable course that ranges from slowly progressive to rapidly destructive. Delay in diagnosis and treatment may lead to an irreversible erosive arthropathy, leading further to physical disability and deformity. The Psoriatic Arthritis Screening and Evaluation (PASE) tool was developed and validated to help dermatologists screen more effectively for PsA; recently, it has been undergoing further validation. An update on the continuing experience with the PASE questionnaire, along with a discussion of why dermatologists have a critical role in screening for PsA, was a major focus of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) annual meeting at Stockholm, Sweden, in June 2009.

Alcohol intake and risk of incident psoriasis in US women: a prospective study.

OBJECTIVES: To evaluate the independent association between alcohol consumption and risk of developing psoriasis and to determine if this risk is associated with different types of alcoholic beverages. DESIGN: A prospective study of female nurses who were followed up from 1991 to 2005. SETTING: Nurses' Health Study II, a cohort of 116,671 US women aged 27 to 44 years in 1991. PARTICIPANTS: The study population included 82,869 women who reported amount and type of alcohol intake on biennial questionnaires. We excluded participants with a history of psoriasis prior to 1991. MAIN OUTCOME MEASURE: Self-report of incident physician-diagnosed psoriasis. For a sensitivity analysis, we had a subset of confirmed psoriasis cases. RESULTS: There were 1150 cases of incident psoriasis, 1069 of which were used for analysis. Compared with women who did not drink alcohol, the multivariate relative risk (RR) of psoriasis was 1.72 (95% confidence interval [CI], 1.15-2.57) for an alcohol consumption of 2.3 drinks/wk or more. When examined by type of alcoholic beverage, there was an association between psoriasis and nonlight beer intake (multivariate RR for ≥ 5 drinks/wk, 1.76; 95% CI, 1.15-2.69); light beer, red wine, white wine, and liquor were not significantly associated with psoriasis risk. The association with nonlight beer intake became stronger in a subset of confirmed psoriasis cases (multivariate RR for ≥ 5 drinks/wk, 2.29; 95% CI, 1.36-3.85). CONCLUSIONS: Nonlight beer intake is associated with an increased risk of developing psoriasis among women. Other alcoholic beverages did not increase the risk of psoriasis in this study.

Development of screening tools to identify psoriatic arthritis.

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis that follows an indolent and progressive course. A delay in diagnosis and treatment may lead to irreversible changes such as erosive arthritis, which lead to permanent physical disability and deformity. Administration of a well-designed screening tool can increase detection of PsA and help determine the prevalence of PsA in a given population. Several tools have been developed to help clinicians screen for PsA. Members of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis recently led an effort to develop and validate three PsA screening tools: the Psoriatic Arthritis Screening and Evaluation tool, the Psoriasis Epidemiology Screening Tool, and the Toronto Psoriatic Arthritis Screen.

Validity, reliability, and sensitivity-to-change properties of the psoriatic arthritis screening and evaluation questionnaire.

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with irreversible joint damage in a subset of individuals. There is a need to screen early for this condition to prevent damage. To meet this need, we have developed the psoriatic arthritis screening and evaluation (PASE) questionnaire. The 15-item PASE questionnaire was administered to 190 individuals with either psoriasis or PsA. The PASE questionnaire was readministered to a subset of individuals with PsA in order to assess test-retest reliability and sensitivity-to-change. Receiver operator curves were constructed to optimize sensitivity and specificity for the diagnosis of PsA. Of the 190 participating in the study, 19.5% (37/191) participants were diagnosed with PsA. PASE total scores ranged from 15 to 74 (possible range, 15-75). The PsA group had a median Total score of 51 (25th and 75th percentile 44 and 57), and non-PsA group had a median total score of 34 (25th and 75th percentile 21 and 49) (p < 0.001). A PASE total score of 44 was able to distinguish PsA from non-PsA participants with 76% sensitivity and 76% specificity. Furthermore, 13 of the 15 items demonstrated significant test-retest reliability as assessed by Pearson correlation coefficient (r >or= 0.5). PASE was sensitive-to-change with therapy; PASE scores were significantly lower for PsA individuals after systemic therapy (p < 0.034). The PASE questionnaire is a valid and reliable tool to screen for active PsA among individuals with psoriasis. PASE scores may be used as a marker of therapeutic response.

Psoriatic arthritis screening tools.

Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, with an indolent and progressive course. A delay in diagnosis and treatment may lead to an erosive arthropathy, leading further to physical disability and deformity. To help clinicians screen for PsA, the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has led an effort to develop and validate 3 PsA screening tools. Administration of a well designed screening tool can increase detection of PsA, help determine the prevalence of PsA in a given population, record clinical data for genotype-phenotype studies, and track response to therapy. The development and validation of these screening tools was a major focus at the GRAPPA annual meeting at Boston in September 2007; we summarize that portion of the meeting.

Wild-type blocking polymerase chain reaction for detection of single nucleotide minority mutations from clinical specimens.

Detection and sequencing of mutations from clinical specimens is often complicated by the presence of an excess of nonmutated cells. To facilitate the detection and sequencing of minority mutations from clinical specimens, we developed wild-type blocking polymerase chain reaction (WTB-PCR). This technique allows sensitive detection of minority mutations in a tissue sample containing excess wild-type DNA. In WTB-PCR, a nonextendable locked nucleic acid (LNA) oligonucleotide binds tightly to a region of wild-type DNA known to develop point mutations. This LNA sequence blocks amplification of wild-type DNA during PCR while permitting amplification of mutant exon 15. Our results show that the LNA blocking oligonucleotide inhibits amplification of wild-type DNA in a dose-dependent manner. WTB-PCR was able to detect mutant DNA in clinical samples of melanoma tissue containing an excess of nonmelanoma cells. This method was also able to detect small amounts of point mutated or tandem mutated DNA diluted with a much larger concentration of wild-type DNA. This rapid and simple assay overcomes the limitations of current methods to detect minority mutations. The potential applications of WTB-PCR include early diagnosis and prognosis of various cancers.