Creating an ultrasound protocol to help identify PsA in PsO patients
Research type
Research Study
Full title
Creating an ultrasound protocol to identify early signs of psoriatic arthritis (PsA) in long term follow-up psoriasis (PsO) patients that do not meet the threshold for rheumatology referral under current NICE guidelines. A cross-sectional, observational study.
IRAS ID
345697
Contact name
Richard Brindley
Contact email
Sponsor organisation
Birmingham city university
Duration of Study in the UK
1 years, 8 months, 31 days
Research summary
Psoriasis (PsO) is a chronic inflammatory skin disease marked by scaly, red patches, affecting about 1.3% to 2.2% of the UK population (approximately 870,000 to 1.5 million people), often occurring before age thirty-five (NICE, 2022).
Psoriatic Arthritis (PsA), closely linked to PsO, can cause significant joint damage if untreated, with prevalence among psoriasis patients estimated between 6% and 42% (about 90,000 to 630,000 individuals) (Gudu et al., 2022). PsA is a painful autoimmune condition that can lead to various symptoms, including synovitis, enthesitis, and tenosynovitis (NICE, 2022; Tucker et al., 2022).
Current NICE guidelines advise dermatologists to use the Psoriasis Epidemiology Screening Tool (PEST) questionnaire for long-term psoriasis patients to check for signs of psoriatic arthritis (PsA). A PEST score of 3 or more calls for a referral to a rheumatologist (NICE, 2022). However, recent studies indicate that many psoriasis patients show these signs without meeting the referral threshold, leading to delays in diagnosis and treatment (Zulianni et al., 2019; Gudu et al., 2022).
Ultrasound is increasingly used to diagnose early signs of psoriatic arthritis (PsA) due to its greater sensitivity in detecting joint and soft tissue inflammation compared to clinical examination (Sarabi et al., 2021). However, there is no consensus on a universal scanning protocol due to disease variability and the time required for scans. This research aims to develop a universal protocol to enhance the Psoriasis Erythrodermic Severity Tool (PEST) questionnaire, allowing for better identification of patients with early subclinical disease. A comprehensive literature review will identify key areas of inflammation that need further investigation along with additional areas identified in practice and those not yet investigated. The study will include extensive ultrasound scans of 250 long-term psoriasis patients, assessing more joints, tendons, and bursae than previous research has explored.
The goal of this research is to simplify the referral process from Dermatology to Rheumatology and assess how many referred patients are diagnosed with psoriatic arthritis (PsA). Aiming to expedite referrals and treatments for psoriasis (PsO) patients facing delays and propose changes to the patient pathway, potentially influencing NICE guidelines to include this new protocol.
REC name
North West - Greater Manchester East Research Ethics Committee
REC reference
25/NW/0205
Date of REC Opinion
19 Aug 2025
REC opinion
Further Information Favourable Opinion