Systematic and Steered Evaluation to Detect Early-onset Musculoskeletal Involvement in Psoriasis Patients

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Introduction: The aim of this study is to evaluate a systematic and steered protocol to detect musculoskeletal involvement in psoriasis patients.Materials and Methods: We made a comparative, cross-sectional, observational, descriptive, and analytical study.We included Mexican mestizo patients over 18 years old with psoriasis.The evaluation protocol included three steps: first, a clinical evaluation (Toronto psoriatic arthritis Screening [ToPAS] questionnaire and inflammatory low back pain [ILB] searching by Assessment of SpondyloArthritis Society criteria); second, patients were categorized according to their symptoms, and third, an image evaluation (OMERACT and Madrid Sonographic Enthesitis Index [MASEI] musculoskeletal ultrasound evaluation and sacroiliac and lumbar magnetic resonance imaging) was performed.Results: We included 75 patients, 33 (44%) of whom were women.Mean age was 44.6 (standard deviation 14.5) years.We found 16 (21.3%)symptomatic patients.Group 1: nine of 11 patients had findings suggestive of inflammatory joint disease.Group 2: only one of seven patients with ILB had inflammatory changes in the sacroiliac joints.Group 3: from the remaining ToPAS and ILB-negative patients, 15 of 27 were detected to have enthesopathy, with a score of MASEI ≥ 20 by ultrasound.The interobserver kappa index for detecting enthesopathy by MASEI index was 0.37.Despite the loss of 33 patients, the systematic protocol detected 26 of 75 patients with musculoskeletal involvement.Conclusion: This systematic and steered approach is useful for hidden inflammatory musculoskeletal involvement in psoriasis patients.