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

Esther Burden-Teh, Kim Thomas, Satyapal Rangaraj , Jo Cranwell , Murphy Ruth

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.
LanguageEnglish
Pages153-160
Number of pages7
JournalClinical and Experimental Dermatology
Volume42
Issue number2
Early online date2 Jan 2017
DOIs
StatusPublished - 14 Feb 2017

Fingerprint

Juvenile Arthritis
Joint Diseases
Psoriatic Arthritis
Psoriasis
Arthritis
Joints
Guidelines
Interviews
Pediatrics
National Institutes of Health (U.S.)
Consultants
Dermatology
Dermatologists
Delivery of Health Care

Cite this

Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening. / Burden-Teh, Esther; Thomas, Kim; Rangaraj , Satyapal; Cranwell , Jo; Ruth, Murphy.

In: Clinical and Experimental Dermatology, Vol. 42, No. 2, 14.02.2017, p. 153-160.

Research output: Contribution to journalArticle

Burden-Teh, Esther ; Thomas, Kim ; Rangaraj , Satyapal ; Cranwell , Jo ; Ruth, Murphy. / Early recognition and detection of juvenile psoriatic arthritis: a call for a standardized approach to screening. In: Clinical and Experimental Dermatology. 2017 ; Vol. 42, No. 2. pp. 153-160.
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abstract = "BackgroundNational 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).AimTo 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.MethodsStructured 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.ResultsOf 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.ConclusionThere 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.",
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