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Background: Psoriatic arthritis (PsA) is an inflammatory arthritis characterised by pain, swelling and stiffness in the joints and affects approximately 0.3 to 1.02% of the UK population [1]. PsA may result in limited physical function and reduced quality of life [2] and is associated with work disability and unemployment [3]. Patients who have the inflammatory skin condition, psoriasis, are at greater risk of developing PsA than those without.
Objectives: There is no definitive test for PsA. It is usually diagnosed by rheumatologists in secondary care, after referral from primary care. Evidence suggests a delay in diagnosis results in worse outcomes for patients. This study is nested within a randomised controlled trial (RCT) of a new clinical care pathway. The RCT is testing whether screening primary care patients with psoriasis for symptoms of PsA leads to earlier diagnosis and improved outcomes, compared to usual care. This qualitative study explored the acceptability and impact of screening.
Methods: Telephone interviews were conducted with patients with psoriasis from two secondary UK care centres taking part in the RCT. The semi-structured interviews explored patients’ thoughts and feelings around screening, the impact of the screening outcome and any changes they made as a result. The semi-structured format allowed flexibility to ask questions that probed more deeply and develop new lines of enquiry based on patients’ responses. Patients who did and did not receive a diagnosis of PsA were interviewed.
Results: Twenty-four patients participated in the study (15 women / 9 men) ranging in age from 35 to 73 years old. The length of time patients had psoriasis ranged from 6 to 60 years. Eleven patients were diagnosed with PsA. A Framework Analysis Approach was used to analyse the data. This allowed for an exploration of the predefined areas (the screening process) as well as remaining open to capturing other related experiences and views of patients. Four main themes represent the data (
| Main theme | Sub-themes |
| 1. Living with psoriasis and psoriatic arthritis: | 1. Understanding of psoriasis – causes, symptoms, treatments |
| ‘It’s [psoriasis] socially debilitating…makes you look a real mess’ | 2. Effects of psoriasis on self, personal and working life |
| ‘It’s almost as if the world’s on your shoulders’ | 3. Awareness of PsA |
| 2. Experience of screening: | 1. Thoughts and feelings prior to screening |
| ‘I was able to talk and be listened to’ | 2. Valuing ‘high quality’ care |
| ‘It’s a lightbulb moment…explained why things were a bit stiff and achy’ | 3. Impact of screening outcome |
| 3. Gaining control: | 1. Increased awareness and knowledge of psoriasis and PsA |
| ‘element of surprise that this arthritis should be connected to it [psoriasis]’ | 2. Improved self-management |
| ‘You’ve got to learn to listen to your body’ | 3. Early diagnosis of PsA |
| 4. Future screening programs: | 1. Changes to questionnaires |
| ‘there weren’t really any questions about were you in pain’ | 2. Use of case studies, sign-posting |
| ‘support groups…peer support is crucial with long-term conditions’ | 3. Removing barriers to screening |
Conclusion: This study indicates screening was viewed as a positive and reassuring experience. Patients valued the fact that screening appointments were not rushed and felt they were being listened to. Patients valued learning about psoriasis and PsA and referred to making changes beneficial to their health. Screening enabled patients to get the help they needed if diagnosed, provided relief if not diagnosed, and sometimes led to the diagnosis of a different condition.
REFERENCES:
[1]Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis 2005;64(Suppl 2):ii14–7
[2]Tillett W, de-Vries C, McHugh NJ. Work disability in psoriatic arthritis: a systematic review. Rheumatology 2012;51:275–83.
[3]Alinaghi F, Calov M, Kristensen LE et al. Prevalence of psoriatic arthritis in patients with psoriasis: a systematic review and meta-analysis of observational and clinical studies. J Am Acad Dermatol 2019;80:251–65.e19
Acknowledgements: On behalf of the PROMPT study team.
Disclosure of Interests: None declared