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Rheumatology (Oxford). 2013 Apr;52(4):705-11. doi: 10.1093/rheumatology/kes355. Epub 2012 Dec 23.

Physician scores vs patient self-report of joint and skin manifestations in psoriatic arthritis.

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  • 1Internal Medicine Department, McMaster University, Hamilton, Ontario, Canada.



We aimed to determine the degree of agreement between patient self-report and physician assessment of joint disease activity and damage and degree of skin disease.


Patients were followed up in the PsA clinic for homunculus for tender joints, swollen joints, deformed joints and problematic joints, as well as the severity of their psoriasis. A rheumatologist documented tender joints, swollen joints and damaged joints as well as psoriasis area and severity index score. The scores were compared using the concordance correlation coefficient and Bland-Altman plots were constructed.


One hundred and forty outpatients participated in the study (60 females and 80 males) with a mean age of 52.8 years. Their mean age at onset of psoriasis was 27.4 years and at PsA onset was 36.9 years. The average duration of psoriasis at the time of the study was 25.3 years and of PsA was 16.2 years. The correlation between patient and physician scores was poor for tender and swollen joints, although it was better for deformed joints and psoriasis area and severity index score but still did not reach a level of good agreement.


PsA patient's self-report has a poor correlation with physician assessment. Thus patient self-reported data are insufficient to accurately monitor PsA disease activity when compared with a physician's joint examination and skin score. Expert physical examination should remain the gold standard for the assessment of actively inflamed joint and skin disease in patients with PsA in both clinical trials and observational cohort studies.

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