Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The Psoriasis Epidemiology Screening Tool (PEST) for psoriatic arthritis is a screening tool that evaluates the likelihood of a patient meeting the criteria for psoriatic arthritis based on their responses to five specific questions. Each response is quantitatively assessed, contributing to a composite score used to interpret the results.

The tool incorporates the following five questions:

1. Have you ever had a swollen joint or joints?
2. Has a doctor ever told you that you have arthritis?
3. Do your fingernails or toenails have holes or pits?
4. Have you had pain in your heel?
5. Have you had a finger or toe that was completely swollen and painful for no apparent reason?

Each question requires a "Yes" or "No" response. "Yes" corresponds to a score of 1, while "No" corresponds to a score of 0. Below is the scoring schema for each response to the questions:

| Question                                                                                       | Yes | No |
|-------------------------------------------------------------------------------------------------|-----|----|
| Have you ever had a swollen joint or joints?                                                   | 1   | 0  |
| Has a doctor ever told you that you have arthritis?                                            | 1   | 0  |
| Do your fingernails or toenails have holes or pits?                                            | 1   | 0  |
| Have you had pain in your heel?                                                                | 1   | 0  |
| Have you had a finger or toe that was completely swollen and painful for no apparent reason?   | 1   | 0  |

The total score is calculated by summing the individual scores from each of the five questions. The total score can range from 0 to 5. Based on the total score, the interpretation is provided as follows:

- If the total score is 3 or more, this suggests the person meets the criteria for psoriatic arthritis.
- If the total score is less than 3, it indicates that the criteria for psoriatic arthritis are not met.

The Psoriasis Epidemiology Screening Tool (PEST) is a clinical calculator used to screen for psoriatic arthritis in patients with psoriasis. Psoriatic arthritis is a type of inflammatory arthritis that affects some people with psoriasis, a condition that features red patches of skin topped with silvery scales. The PEST calculator is designed to identify patients who may have psoriatic arthritis but have not yet been diagnosed, allowing for earlier intervention and treatment. 

The PEST calculator is applicable to patients with psoriasis, particularly those with a long history of the disease, as the risk of developing psoriatic arthritis increases over time. The clinical utility of this calculator is to facilitate early detection of psoriatic arthritis, which can help prevent or slow down joint damage and disability.

There are no specific exclusion criteria for the use of the PEST calculator. However, it should be noted that a positive PEST score does not confirm a diagnosis of psoriatic arthritis, but rather indicates a need for further evaluation by a rheumatologist.

Psoriasis Epidemiology Screening Tool for psoriatic arthritis (PEST)

Psoriasis

Topical therapy

Topical therapy (salicylic acid)

Combination therapy

Combination therapy, etanercept in combinations

Screening for cardiovascular disease

Screening for CVD

Narrowband ultraviolet B phototherapy

NB-UVB phototherapy (cautions)

NB-UVB phototherapy, combination therapy

NB-UVB phototherapy (indications)

Non-biologic agents

Non-biologic agents, methotrexate

Initiating biologic therapy

Initiating biologic therapy, general considerations

Topical therapy, tazarotene

Screening for tuberculosis

Combination therapy, adalimumab in combinations

Targeted ultraviolet B phototherapy

Targeted UVB phototherapy (combination therapy)

Surveillance for infectious complications

Broadband ultraviolet B phototherapy

BB-UVB phototherapy (combination therapy)

Topical therapy, vitamin D analogs

Biologic agents

Biologic agents, etanercept

Biologic agents (secukinumab)

Topical therapy (combination with systemic therapy)

Non-biologic agents (cyclosporine)

Combination therapy (infliximab in combinations)

Patients considering conception, pregnancy, and breastfeeding

Immunizations

Topical therapy (anthralin)

Screening for metabolic syndrome

Targeted UVB phototherapy (dosing)

Patients with latent tuberculosis

Biologic agents (adalimumab)

Biologic agents (guselkumab)

Initiating biologic therapy, choice of agent

Patients with hepatitis B or C infection

Biologic agents (ixekizumab)

Topical therapy, corticosteroids

Topical therapy (calcineurin inhibitors)

Targeted UVB phototherapy (indications)

Screening for psoriatic arthritis

Non-biologic agents (acitretin)

Psoralen-ultraviolet A phototherapy

PUVA phototherapy

Screening for viral infections

Topical therapy (coal tar)

Biologic agents (risankizumab)

BB-UVB phototherapy (indications)

Screening for anxiety and depression

Screening for inflammatory bowel disease

Screening for IBD

BB-UVB phototherapy (cautions)

Patients with gluten intolerance

Severity assessment

General counseling

Initiating biologic therapy (contraindications)

NB-UVB phototherapy (dosing)

Patients with vulvar psoriasis

Biologic agents (brodalumab)

Patients at higher risk of cancer

Switching between biologic agents

Topical therapy, combination with topicals

Initial assessment

Lifestyle modifications

Other phototherapies

Patients with human immunodeficiency virus infection

Patients with HIV infection

Evaluation before biologic therapy

Monitoring during biologic therapy

Combination therapy (ustekinumab in combinations)

Biologic agents, infliximab

Preoperative management of systemic therapy

Non-biologic agents (apremilast)

Biologic agents (tildrakizumab)

Biologic agents (ustekinumab)

Psoriasis

Guidelines

Key sources