Audit on Skin and Quality of Life Assessment of Psoriatic Arthritis

Background

Skin involvement in PsA is associated with worsened overall health related quality of life, increased health care utilisation. Skin disease is assessed objectively through PASI score. As per BSR guidelines for treatment of PsA, skin and quality of life (QOL) assessment is an important domain in deciding escalation of treatment for biologics. Assessment of skin aids in selection of the type of biologic.

Methods

20 patients with psoriatic arthritis were assessed in rheumatology outpatient clinics of East Lancashire Hospitals NHS trust, UK. The last letter to GP of each patient was reviewed. Data on objective assessment (PASI Score) and subjective assessment (mild, moderate or severe) or no assessment of skin disease along with QOL assessment was recorded. Staff were educated to assess PASI score, using mobile application “GRAPPA”, calculate and document. All patients with psoriatic arthritis were given the Dermatology Life Quality Index (DLQI) questionnaire. BSR 2022 guidance on PsA was considered as the standard reference.

 After 3 months of intervention, data were analysed the effectiveness of the intervention.

Results

Pre intervention results showed a subjective assessment of 10 (50%), Objective assessment of skin disease 0(0%), and DLQI assessment of 0 (0%). Post intervention results showed an improvement of objective assessment of skin via PASI score to 10 (50%). Another 8 (40%) of patients had subjective assessment of skin. DLQI assessment improved to 4(20%).

Conclusion

Introduction of convenient mobile application to assess skin involvement of PsA had shown remarkable improvement of PASI score. DQOLI patient questionnaire improved QOL assessment in PsA patients.

 Change of practice through objective skin assessment through PASI score and assessment of DQOLI lead to escalation of treatment to biologics. In addition, PASI score helped in selection of most appropriate biologic that targets both skin and joints.