When evaluating patient-driven psoriatic arthritis (PsA) screening and rheumatology referrals, more than half of the referrals were deemed appropriate in providing reassurance and valuable patient education, according to Megan Meier, MD, during her presentation at the American College of Rheumatology (ACR) Convergence meeting in Philadelphia.

Dr Meier is an internist at the University of Utah in North Salt Lake, Utah, where she is also affiliated with Intermountain Medical Center.

To overcome a fairly common problem of diagnostic delay of PsA among patients because of busy clinical practices, a direct-to-patient (D2P) system was established to encourage a home screening survey among patients. This method bypassed an initial screening by primary caregivers, Dr Meier noted. Through the Psoriasis Epidemiology Screening Tool survey, Dr Meier and colleagues “sought to characterize the patient findings during the initial rheumatologic evaluation and to determine if the referrals to the rheumatologists were appropriate.”

Patients with an International Classification of Diseases (ICD) code for psoriasis but not for PsA in the electronic health record (EHR) from the University of Utah and VA Medical Center health care systems in Salt Lake City answered the survey electronically. Patients that screened positively contacted rheumatology staff for further evaluation, upon which the patient characteristics, clinical findings, and diagnostic outcomes were listed.

For the purposes of the study, Dr Meier and colleagues set aside certain parameters to decide if it would be appropriate to refer the patient to a rheumatologist. It was deemed appropriate if the patient had a history of confirmed or probable psoriasis; no previous visit with a rheumatologist within the last 6 years; a diagnosis of PsA; and symptoms, examination findings, or test results that warranted an additional workup or a rheumatology follow-up.

Out of the 1,413 patients, 27 met with a rheumatologist. Most patients were male (66.6%) with the mean age of 61.5 years. While “14.8% had a previous encounter with a rheumatologist that was nondiagnostic for PsA, 59.2% had a verified history of psoriasis by a dermatologist or primary care provider,” Dr Meier said. The most common clinical finding was enthesitis (33.3%) of the Achilles, plantar fascia insertions, or epicondyles.

The key takeaway point was that “the rheumatology referral was deemed appropriate in 63%.”

Dr Meier said among the patient-driven PsA screening and rheumatology referrals, a majority of those were deemed appropriate. If the misdiagnosed cases of psoriasis were high, it was due to inaccurate ICD code data. The consensus was that an evaluation by a rheumatologist was highly beneficial in providing assurance to high-risk patients and in valuable patient education.

­—Priyam Vora

Reference:
Meier M. Poster 0401. Direct to patient screening of psoriatic arthritis: clinical findings and outcomes of patient-driven rheumatology referrals. Presented at: American College of Rheumatology Convergence. November 12, 2022.