PsACT-US Study

• Research type

  Research Study

• Full title

  Do patients with skin PSoriasis have sub-clinical features of ACTive psoriatic arthritis on musculoskeletal UltraSound? PsACT-US Study

• IRAS ID

  288492

• Contact name

  George Hirsch

• Contact email

  g.hirsch@nhs.net

• Sponsor organisation

  The Royal Wolverhampton NHS Trust

• Clinicaltrials.gov Identifier

  NCT04857476

• Clinicaltrials.gov Identifier

  N/A, N/A

• Duration of Study in the UK

  2 years, 7 months, 1 days

• Research summary

  Research Summary

  Psoriatic Arthritis is an inflammatory condition that typically affects joints and soft tissues such as tendons. Poorly controlled or untreated psoriatic arthritis can lead to joint damage, disability and poor physical and mental wellbeing. Evidence suggests that early diagnosis and treatment of psoriatic arthritis can minimise adverse health outcomes.
  Musculoskeletal ultrasound has become an extremely useful tool in aiding rheumatologists to diagnose inflammatory joint conditions particularly at an early stage in the course of a disease.
  Psoriatic arthritis is known to affect up to 30% of patients with skin psoriasis. Therefore, national dermatology guidelines advise that patients with skin psoriasis should be asked about any joint symptoms at least every year.
  This study investigates whether skin psoriasis patients who are not on biologic treatment are indeed being asked about any joint symptoms as we invite patients for a musculoskeletal ultrasound scan to see if they have features of early psoriatic arthritis on ultrasound. Those who do are then invited for a thorough rheumatology clinical assessment.

  Summary of Results

  Patient Characteristics: During the period of time available, eight patients with plaque psoriasis were assessed. Six (75%) of these patients were male and two(25%) were female. The average age of participants was 50.3 years.
  Overall, three (37.5%) of patients were on a systemic drug treatment for psoriasis. The average PEST score (Psoriasis Epidemiology Assessment Tool; a questionnaire used to identify psoriatic arthritis in patients with psoriasis) was 1.75 in the whole group (where above 3 is the score which typically suggests referral to rheumatology. )

  Results: Overall, four (50%) of the patients examined had findings on ultrasound examination that suggested a diagnosis of psoriatic arthritis and all were seen in an NHS rheumatology clinic for further treatment after the study appointment. The average PEST score was 2 in the group with feature of arthritis and 1.5 in the group without arthritis.

  Discussion: Unfortunately, we were not able to recruit the number of patients to our study that we had planned. This does not allow us to make any confident statements about how many patients currently being treated for psoriasis by dermatology clinics have undiagnosed psoriatic arthritis. Of the patients we examined, who did not know that they had psoriatic arthritis, half had ultrasound evidence that suggested a diagnosis of psoriatic arthritis.
  Because of the small number of patients seen, this could be a chance finding but it also suggests that further, larger studies of ultrasound in patients who have psoriasis would be worthwhile.

  Conclusion: Ultrasound may have a role to play as a sensitive tool in diagnosing psoriatic arthritis but our study was too small to be sure about this.

• REC name

  West of Scotland REC 5

• REC reference

  21/WS/0060

• Date of REC Opinion

  26 May 2021

• REC opinion

  Further Information Favourable Opinion