Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening

Burden-Teh, Esther; Thomas, K.S.; Rangaraj, S.; Cranwell, J.C.; Murphy, R.

Abstract

Background: National Institute for Health and Care Excellence (NICE) guidelines recommend annual screening for psoriatic arthritis (PsA) in all patients with psoriasis. Currently, no validated assessment tools have been recommended for screening for juvenile PsA (JPsA).

Aim: To determine dermatologists' practice when assessing children's joints and explore the challenges dermatologists experience when looking for joint disease, in order to inform future strategies to improve early detection of arthritis.

Methods: Structured telephone interviews were undertaken with dermatologists identified through the British Society of Paediatric Dermatology. Percentages for binary and categorized responses were calculated. Thematic content analysis was used to generate a set of core themes across the interview data.

Results: Of the 41 consultant dermatologists contacted, 23 agreed to be interviewed. Of these, 78% (18/23) reported they routinely ask about joint disease. Only 13% (3/23) routinely examine the joints of children with psoriasis. Overall, assessment for JPsA lacked a structured, evidence-based approach. The average confidence rating for assessing joint disease was low (score of 3). The two key barriers described for detecting arthritis were a lack of experience and training, and subtle or difficult to detect signs. The two main suggestions for improving detection were the introduction of an assessment tool/guideline and increased clinical experience and training.

Conclusion: There is a clear need for dermatologists to use a standardized approach for screening and to increase their confidence in paediatric musculoskeletal examination. In this article, we provide guidance on screening for psoriatic arthritis in children based on our clinical experience.

Citation

Burden-Teh, E., Thomas, K., Rangaraj, S., Cranwell, J., & Murphy, R. (2017). Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening. Clinical and Experimental Dermatology, 42(2), 153-160. https://doi.org/10.1111/ced.13010

• Journal Article Type: Article
• Acceptance Date: Mar 30, 2016
• Online Publication Date: Jan 2, 2017
• Publication Date: Mar 1, 2017
• Deposit Date: Apr 1, 2016
• Publicly Available Date: Jan 2, 2017
• Journal: Clinical and Experimental Dermatology
• Print ISSN: 0307-6938
• Electronic ISSN: 1365-2230
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 42
• Issue: 2
• Pages: 153-160
• DOI: https://doi.org/10.1111/ced.13010
• Public URL: https://nottingham-repository.worktribe.com/output/842645
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/ced.13010/abstract
• Additional Information: This is the peer reviewed version of the following article: Burden-The, E., Thomas, K.S., Rangaraj, S., Cranwell, J.C., Murphy, R. Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening, which has been published in final form at: http://dx.doi.org/10.1111/ced.13010 This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
• Contract Date: Apr 1, 2016