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G258A Improving the diagnosis of Juvenile Psoriatic Arthritis: How can specialties learn from each other
  1. E Burden-Teh1,2,
  2. K Thomas1,
  3. S Rangaraj3,
  4. J Cranwell4,
  5. R Murphy2,5
  1. 1Centre of Evidence Based Dermatology, University of Nottingham, UK
  2. 2Paediatric Dermatology Department, Nottingham Children’s Hospital, Nottingham, UK
  3. 3Paediatric and Adolescent Rheumatology Department, Nottingham Children’s Hospital, Nottingham, UK
  4. 4Division of Epidemiology & Public Health, University of Nottingham, Nottingham, UK
  5. 5Dermatology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK

Abstract

Introduction Recognition of inflammatory arthritis by paediatric dermatologists and recognition of psoriasis by paediatric rheumatologists are important for the early diagnosis of juvenile psoriatic arthritis (JPsA). Early diagnosis and treatment are necessary to prevent permanent joint damage and disability. The delay between the onset of disease and diagnosis is longer for juvenile psoriatic arthritis compared to other types of childhood inflammatory arthritis.

National Institute for Health and Care Excellence (NICE) guidelines recommend annual screening for psoriatic arthritis in all patients with psoriasis. Currently, no validated assessment tools have been recommended for screening forJPsA. Local experience in the combined paediatric dermatology and rheumatology clinics have shown how the diagnosis of psoriasis in children may be easily missed, especially if the affected areas are in ‘hidden’ sites such as the natal cleft.

Methods Structured telephone interviews were undertaken with dermatologists and paediatric rheumatologists. Clinicians were identified through the British Society of Paediatric Dermatologists and the British Society of Paediatric and Adolescent Rheumatology.

Results Twenty three of the 41 consultant dermatologists and ten out of the twelve paediatric rheumatologists from the specialist commissioned paediatric rheumatology centres contacted agreed to be interviewed.

Seventy eight percent (18/23) of dermatologists 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 two main suggestions for improving detection were the introduction of an assessment tool/guideline and increased clinical experience and training.

Fifty percent of paediatric rheumatologists examine and ask about ‘hidden sites’ but only 10% examine the natal cleft and 20% examine the groin. The two main suggestions for improving diagnosis of psoriasis were experiential training/clinical education and a close working relationship with dermatology. Most clinicians (90%) would recommend pGALs as a screening tool for JPsA.

Conclusion There is a need for dermatologists to use a standardised and effective approach, such as pGALS, when assessing for JPsA. There is also a need to improve awareness amongst paediatric rheumatologists for hidden site psoriasis. Both these objectives could be supported by a close working relationship between the two specialities.

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