Question Yes No

More than 3 years

More than 5 years

1 *Have you ever had joint pain accompanied by swelling?* 2 *Have you ever had a completely swollen digit or toe?*  3 *Have you ever had joint pain accompanied by redness of that* 

4 *Do your joints feel stiff after waking up in the morning?*

6 *Have you ever consulted a doctor because of your joint* 

*pain…. (please, answer questions 8a to 8d)* 10 *… most intense in the early morning hours?* 11 … *improve through exercising or moving around?*

13 *… accompanied by back stiffness in the morning hours?* 14 *If you answered one of the above questions with "YES": Since when do you have these complaints?* 

> More than 3 months

More than 6 months

Table 2. The GEPARD questionnaire targets arthritic complaints of peripheral joints and spinal manifestations in addition of duration of arthritic symptoms thus enableing early detection of PsA. The patient alone answers the questionnaire. The physician or assistant counts the positive answers. The cut-off value of equal or more than 4 positive answers showed a sensitivity of 89% and a specificity of 73% to detect PsA in Ps patients

More than 1 year

5 *Have you ever thought of having a joint disease?*

7 *Have you ever received the diagnosis of "arthritis"?* 8 *Do you take pain medication for your joint pain?* 9 *Do you suffer from back- or buttock pain? If yes, does/is this* 

*joint?*

*problems?*

12 … *persist while resting?*

More than 1 month

More than 1 week

manifestations in the dermatology setting.

question related to the time period since the first occurrence of complaints lasting from one week up to more than 5 years in order to detect early PsA manifestations. In the statistical evaluation of the study, we calculated a cut-off value of greater than or equal to 4 positive answered questions. This cut-off showed a sensitivity of 89% and a specificity of 73% to detect PsA in Ps patients (Härle, 2010).

In the final evaluation, we clinically evaluated 54 patients. These patients were selected by the GEPARD questionnaire from dermatology outpatient clinics. We found 43 patients who had some arthritic manifestations according to clinical examination, ultrasound, x-ray, MRI, and Technecium-Szintigraphy. This accounts for 79,6% patients being positive for PsA manifestation. This percentage of PsA among patients with Ps is in line with earlier publications (Sadek, 2007). Furthermore, 23 patients were first diagnosed as having PsA.

According to the time duration of arthritic complaints we found 57% suffering over 4 years but 43% of patients below 4 years (figure 4) which may still be considered as being early arthritis. From these patients with complaints of less than 4 years 80% could be classified for PsA just by clinical examination according the CASPAR criteria without the use of sonography, x-ray, MRI, or szintigraphy (figure 5). Considering that the initial screening process was exclusively based on patients' answers, without evaluation by a physician, the GEPARD patient - questionnaire is well suited for routine clinical usage. In addition, the screening tool does not consume additional time from the dermatologist but still enables him to identify patients who need to be referred to a rheumatologist for further evaluation of arthritic manifestation.

Fig. 4. Pie chart of arthritis duration according to the GEPARD patient-questionnaire. Fortythree percent suffered of symptoms of less than 4 years. Less than 4 years is considered to be early arthritis.

Detecting Psoriasis Arthritis Early in the Disease Course – Why This

in order to treat all facets of PsA.

is Important and How Dermatologists and Rheumatologists Can Successfully Cooperate? 73

In the case of leading arthritis, the consultation of the dermatologist is necessary to confirm the diagnosis of Ps by clinical means or by biopsy in unclear situations (figure 7). Furthermore, topical treatment may be instituted if systemic therapy of PsA does not lead to full treatment success of the skin. The same treatment cycle as described before is necessary

Fig. 6. Flow chart of possible cooperation among the medical disciplines. Screening starts

in the dermatology practice by using the GEPARD patient self-administered

questionnaire.

Fig. 5. Distribution of arthritis, arthralgia and no complaints in percent of GEPARD patientquestionnaire early arthritis patients (≤ 4 years). According to the CASPAR classification criteria, eighty percent were classified as having PsA.
