Name: Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients
Uploaded: 2024-03-01T13:45:00
Description: Read this Scientific Article Protocol about Measuring Psoriasis Severity at Home at JoVE.com

This study has been supported by the Discovery Research Grant (B.-J.F.) and the PsA Diagnostic Test Grant (B.-J.F. and J.A.W.) from the National Psoriasis Foundation, and the Utah Genome Project Partnership Grant (B.-J.F. and J.A.W.) and the Immunology, Inflammation, &#38; Infectious Disease (3i) Initiative Seed Grant (B.-J.F. and J.A.W.) from the University of Utah. The author would like to thank Tyler S. Nelson (Physician Assistant, University of Utah Department of Dermatology) and Angela Contreras (Study Coordinator, University of Utah Department of Dermatology) for recruiting patients for the study.

This study was approved by the University of Utah Institutional Review Board (IRB_00137694). Twenty-seven psoriasis patients at the University of Utah dermatology clinic were enlisted to complete a questionnaire about psoriasis severity at the time of the questionnaire&#39;s administration. All patients provided informed consent and completed the questionnaire without instructions from research or medical personnel, either before or immediately after the dermatologist&#39;s assessment.
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Development and Evaluation of a Self-Assessment Tool for Psoriasis Severity

<ol>
	<li>Merola, J. F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Incidence+and+prevalence+of+psoriatic+arthritis+in+patients+with+psoriasis+stratified+by+psoriasis+disease+severity:+Retrospective+analysis+of+an+electronic+health+records+database+in+the+United+States.">Incidence and prevalence of psoriatic arthritis in patients with psoriasis stratified by psoriasis disease severity: Retrospective analysis of an electronic health records database in the United States.</a> Journal of the American Academy of Dermatology. 86 (4), 748-757 (2022).</li><li>Eder, L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+incidence+and+risk+factors+for+psoriatic+arthritis+in+patients+with+psoriasis:+a+prospective+cohort+study.">The incidence and risk factors for psoriatic arthritis in patients with psoriasis: a prospective cohort study.</a> Arthritis &amp; Rheumatology. 68 (4), 915-923 (2016).</li><li>Haroon, M., Gallagher, P., FitzGerald, O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+delay+of+more+than+6+months+contributes+to+poor+radiographic+and+functional+outcome+in+psoriatic+arthritis.">Diagnostic delay of more than 6 months contributes to poor radiographic and functional outcome in psoriatic arthritis.</a> Annals of the Rheumatic Diseases. 74 (6), 1045-1050 (2015).</li><li>Belman, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psoriasis+characteristics+for+the+early+detection+of+psoriatic+arthritis.">Psoriasis characteristics for the early detection of psoriatic arthritis.</a> The Journal of Rheumatology. 48 (10), 1559-1565 (2021).</li><li>Tey, H. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Risk+factors+associated+with+having+psoriatic+arthritis+in+patients+with+cutaneous+psoriasis.">Risk factors associated with having psoriatic arthritis in patients with cutaneous psoriasis.</a> The Journal of Dermatology. 37 (5), 426-430 (2010).</li><li>Rouzaud, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Is+there+a+psoriasis+skin+phenotype+associated+with+psoriatic+arthritis?+Systematic+literature+review.">Is there a psoriasis skin phenotype associated with psoriatic arthritis? Systematic literature review.</a> Journal of the European Academy of Dermatology and Venereology JEADV. 28, 17-26 (2014).</li><li>Gladman, D. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Development+and+initial+validation+of+a+screening+questionnaire+for+psoriatic+arthritis:+the+Toronto+Psoriatic+Arthritis+Screen+(ToPAS).">Development and initial validation of a screening questionnaire for psoriatic arthritis: the Toronto Psoriatic Arthritis Screen (ToPAS).</a> Annals of the Rheumatic Diseases. 68 (4), 497-501 (2009).</li><li>Tom, B. D. M., Chandran, V., Farewell, V. T., Rosen, C. F., Gladman, D. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Validation+of+the+Toronto+Psoriatic+Arthritis+Screen+Version+2+(ToPAS+2).">Validation of the Toronto Psoriatic Arthritis Screen Version 2 (ToPAS 2).</a> The Journal of Rheumatology. 42 (5), 841-846 (2015).</li><li>Husni, M. E., Meyer, K. H., Cohen, D. S., Mody, E., Qureshi, A. 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A., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=PAPRIKA:+A+question+bank+for+assessing+psoriatic+arthritis+risk+in+individuals+of+diverse+ancestries.">PAPRIKA: A question bank for assessing psoriatic arthritis risk in individuals of diverse ancestries.</a> Arthritis Care &amp; Research. , (2023).</li><li>Feldman, S. R., Krueger, G. G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psoriasis+assessment+tools+in+clinical+trials.">Psoriasis assessment tools in clinical trials.</a> Annals of the Rheumatic Diseases. 64, 65-68 (2005).</li><li>McHugh, M. 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Protocol step 1.4 is a crucial aspect of the proper construction of the Psoriasis Thickness Reference Card. To achieve an accurate representation of plaque thickness, it is imperative to avoid placing the tape vertically or flush against the vertical edge of the stack of sticky notes. If the tape is positioned in such a manner, the sharp edge of each stack will not mimic the feel of a psoriasis plaque. The tape should be applied in a way that creates a smooth slope connecting the stack to the paper.
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Psoriatic arthritis (PsA) is an inflammatory arthritis that develops in approximately 2.9% of patients with psoriasis each year1,2. Early prediction of which patients will develop PsA is crucial for a patient&#39;s quality of life as a diagnostic delay of as little as six months may cause irreversible damage to the joints3. A previous study had identified features associated with early-stage PsA. The three components of the Investigator&#39;s Global Assessment (IGA)-induration (thickness), erythema (redness), and desquamation (scaliness)-were highly correlated with each other and were nominally associated with subsequent PsA development. Multivariate analysis showed that a history of fingernail psoriasis and untreated induration of psoriasis lesions were independent PsA predictors4. Other studies have also identified psoriasis severity as associated with psoriatic arthritis2,5,6. The collection of these clinical factors is likely to be important in future PsA screening.
Several PsA screening tests exist7,8,9,10, but they require physicians to conduct them. A questionnaire-based screening test that can be completed by patients without physician assistance is an ideal format because it will not burden the dermatology and primary care clinics. Previously, the authors described a questionnaire with images that depict different severities of erythema and desquamation in multiple skin tones11. However, the measurement of induration requires a reference card corresponding to various plaque severities, such as that developed by the National Psoriasis Foundation12. The reference card is characterized by multiple raised areas of varying elevations, each corresponding to a number representing induration severity. To assess a patient&#39;s psoriasis severity in terms of induration, the card user compares the thickest psoriasis patch on a patient&#39;s body to the elevated areas on the card.
However, distributing a reference card to psoriasis patients may not be the most efficient approach for reaching a broad audience, especially for patients located outside the USA and for online survey studies. For researchers and clinicians gathering induration self-assessments from numerous patients, an alternative option could involve creating a homemade induration card using inexpensive office supplies. For patients, creating a homemade device from inexpensive office supplies can be more cost-effective than purchasing commercially available alternatives. This protocol describes how to create the Psoriasis Thickness Reference Card, an induration reference card that psoriasis patients can feel to assess the severity of their psoriasis induration. The Card can be made with standard office supplies and is inexpensive to make.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Post-it Notes, 1 3/8 in x 1 7/8 in, Canary Yellow, 6 Pads/Pack</td>
			<td>3M</td>
			<td>00021200569029</td>
			<td>The smallest sized sticky notes (5.08 cm height x 5.08 cm width or 5.08 cm height x 3.81 cm width) work best with the printed template. The thickness of each sticky note should be between 0.09 and 0.1 mm; sticky notes from the brands Post-it, Pen+Gear, and Office Works meet these requirements.</td>
		</tr>
		<tr>
			<td>Printworks Printer and Copy Paper - 500 Pack - White</td>
			<td>Paris Corporation</td>
			<td>0009014600006</td>
			<td>Any brand of printer paper is acceptable; if recreating the template manually rather than printing, any brand of paper is acceptable.</td>
		</tr>
		<tr>
			<td>R</td>
			<td>http://www.r-project.org</td>
			<td></td>
			<td>The R programming language version 4.3.1 was used to analyze the data in this study.&#160;</td>
		</tr>
		<tr>
			<td>Scotch Magic Tape Dispensered Rolls</td>
			<td>3M</td>
			<td>00021200000041</td>
			<td>Any brand of smooth adhesive tape is acceptable; do not use tape with a coarse texture.</td>
		</tr>
	</tbody>
</table>

measuring psoriasis severity at home

Psoriasis plaque severity metrics, such as induration (thickness), erythema (redness), and desquamation (scaliness), are associated with the subsequent development of psoriatic arthritis (PsA) among cutaneous-only psoriasis patients (patients with skin or nail psoriasis but no psoriatic arthritis). These metrics can be used for PsA screening. However, a key challenge in PsA screening is to optimize accessibility and minimize costs for patients, while also reducing the burden on healthcare systems. Therefore, an ideal screening tool consists of questions that patients can answer without a physician's assistance. Although reference images can be used to help a patient self-assess erythema and desquamation severity, a patient would need a tactile induration reference card to self-assess induration severity. This protocol describes how to create an induration reference card, the Psoriasis Thickness Reference Card, as well as how to use it to assess lesion induration severity. Administration of reference images for erythema and desquamation and a Psoriasis Thickness Reference Card for induration to 27 psoriasis patients showed that patients were moderately successful at self-assessing the severity of these three metrics. These findings support the feasibility of a future PsA screening test that patients can complete without the need for physician assistance.

Author Spotlight: Self-Assessment Protocol for Predicting Psoriatic Arthritis in Psoriasis Patients

Measuring Psoriasis Severity at Home

Our research focuses on the healthcare of patients affected with psoriasis and psoriatic arthritis. One of the questions we try to answer is how to predict psoriatic arthritis among psoriasis patients using a cost-efficient approach that is accessible to remote locations. Our protocol enables patients to measure the severity of their psoriasis lesions without the need for a physician's assistance.They can even perform these assessments at home. The protocol will improve population-based research by expanding patient outreach and accessibility. Additionally, patient can utilize the protocol for direct treatment response effectively.

To validate whether patient assessments of desquamation, erythema, and induration are comparable to those of a dermatologist, 27 psoriasis patients at the University of Utah dermatology clinic were enlisted to complete a questionnaire about psoriasis severity at the time of the questionnaire&#39;s administration. Each participant was provided with a Psoriasis Thickness Reference Card along with the questionnaire. The dermatologist provided their independent assessment of the current status of each patient using the same ...

Read this Scientific Article Protocol about Measuring Psoriasis Severity at Home at JoVE.com

This paper details the creation of a Psoriasis Thickness Reference Card, enabling psoriasis patients to self-assess their psoriasis plaque thickness without the need for physician assistance. Additionally, the precision of self-assessment for psoriasis redness and scaliness by employing reference images depicting various skin tones is assessed.

Psoriasis plaque severity metrics, such as induration (thickness), erythema (redness), and desquamation (scaliness), are associated with the subsequent ...

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Procedure for Making a Psoriasis Thickness Reference Card and its Usage

To begin, write down the number 0, 3, 5, 8, 10, and 13 on any paper to make the psoriasis thickness reference card. Take a package of sticky notes. Sequentially place stacks of 3, 5, 8, 10, and 13 sticky notes on the boxes labeled with respective numbers, aligning the adhesive side of the sticky notes on the left side of each corresponding box.Firmly adhere each stack to the paper. Apply a strip of tape along the right side of each stack of sticky notes. Ensure the tape adheres smoothly, creating a gentle slope between the top of the stack and the paper.Slide a finger across the edge of the thickest psoriasis patch, noting its elevation from the surrounding skin. Similarly, slide a finger across the taped side of each stack of sticky notes to assess their thickness. Identify the stack that best matches the elevation of the thickest psoriasis patch and record the corresponding score.There was no significant difference between patient and physician reports of desquamation, erythema, and induration by the Wilcoxon signed rank test.