Undiagnosed Psoriatic Arthritis among Psoriasis Patients: A Meta-analysis of its Prevalence

Author(s):

Alanoud Farraj Al Alshaikh, Doaa Izzeldin Elsheikh, Sarah Eissa Alkhamisi, Lujain Shaker BinLadin, Marwa Rashad Gammash, Mohamed Samir Gul, Fahad Saud Alanazi, Manal Mansoor BinJawad, Abeer Fahad Almutairi, Moath Khalid Albusair and Omar Osama Shahada

Background: Evaluation of the prevalence of PsA in patients with psoriasis has ranged broadly from 7% to 48%. This variability is related in part to the definition of the disorder, source of patients, and geographic variation. Aim: This work aims to determine the prevalence of undiagnosed Psoriatic Arthritis (PsA) among psoriasis patients. Materials and Methods: A systematic search was performed over different medical databases to identify Dermatology studies, which studied the prevalence of undiagnosed PsA among psoriasis patients. Using the meta-analysis process, either with fixed or random-effects models, we conducted a meta-analysis on overall PsA prevalence as a primary outcome, and on psoriasis severity in PsA patients as a secondary outcome, which was assessed via Psoriasis Area and Severity Index (PASI). Results: Ten studies were identified involving 97762 psoriasis patients. The metaanalysis process revealed that the estimated pooled prevalence of undiagnosed PsA among psoriasis patients was (13.76%) (95% CI 6.689 to 22.856). We also found a highly significant increase in mean PASI, in PsA patients compared to the remaining dermal psoriasis (p<0.0001). Conclusion: To conclude, the findings are consistent with a low prevalence of PsA among patients with psoriasis and confirm a high percentage of undiagnosed cases with active arthritis among PsA patients in dermatologist’s office. Dermatologists should screen for PsA in their patients, especially those with risk characteristics and early signs.