Can a Novel Tool Predict the Risk of Developing Psoriatic Arthritis Among Those With Psoriasis?

Researchers investigating the validity of a novel risk prediction model for the development of psoriatic arthritis, known as the Psoriatic Arthritis Risk Estimation Tool (PRESTO), found that the prediction tool was reliable for estimating the development of psoriatic arthritis (PsA) among patients with psoriasis.

The research involved the analysis of data from the prospective Toronto Psoriasis Cohort of patients with psoriasis (n = 635) who did not have PsA at the time of enrollment. These patients were monitored annually by rheumatologists for the potential development of PsA. To build the prediction model, researchers included a comprehensive set of variables, including demographic information, psoriasis characteristics, comorbidities, medications, and musculoskeletal symptoms. The researchers estimated the risk of developing PsA over 1- and 5-year periods and evaluated the model's performance using area under the curve (AUC) and calibration plots.

A total of 51 and 71 patients developed PsA within 1 year and 5 years, respectively. The identified risk factors for PsA development within 1 year included younger age, male sex, a family history of psoriasis, symptoms like back stiffness, nail pitting, and joint stiffness, the use of biologic medications, patient global health, and pain severity. The AUC for this model was 72.3, indicating reasonable predictive accuracy.

For PsA development within 5 years, factors such as morning stiffness, psoriatic nail lesions, psoriasis severity, fatigue, pain, and the use of systemic non-biologic medications or phototherapy were associated with an increased risk. The AUC for this model was 74.9, suggesting even better predictive performance for PRESTO.

“The development of PsA within clinically meaningful time frames can be predicted with reasonable accuracy for patients with psoriasis using readily available clinical variables,” the authors concluded.

Reference:

Eder L, Lee KA, Chandran V, et al. Derivation of a multivariable psoriatic arthritis risk estimation tool (PRESTO): a step towards prevention. Arthritis Rheumatol. Published August 9, 2023. doi:10.1002/art.42661