Streamlining Psoriatic Arthritis Screening and Management Using the IDEOM Clinical Framework: A Quality Improvement Initiative

August 2025 | Volume 24 | Issue 8 | 777 | Copyright © August 2025


Published online July 31, 2025

Sarah Romanelli BSa, Gretchen D. Ball BSa, Hassan Hamade MDa, Melissa P. Zundell BSa, Sangyoon Shin DOa, Thami Senthilkumaran BSa, Angela Lamb MDa, Saakshi Khattri MDa, Lourdes Perez-Chada MD MMScb, Joseph F. Merola MD MMScc, Alice B. Gottlieb MD PhDa

aDepartment of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY
bDepartment of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
cDepartment of Dermatology and Department of Medicine, Division of Rheumatology, UT Southwestern Medical Center, Dallas, TX

Abstract
Background: Psoriatic arthritis (PsA) is undiagnosed in up to 41% of cases, risking irreversible joint damage if untreated. This quality improvement initiative facilitates PsA screening, assessment, and rheumatology referral to improve patient outcomes.
Methods: Our clinical framework integrated the Psoriasis Epidemiology Screening Tool (PEST) and the 12-item Psoriatic Arthritis Impact of Disease questionnaire (PsAID-12) into the electronic medical record system in 26 dermatology clinics. Psoriasis (PsO) patients underwent PsA screening via the PEST. Those scoring ≥3 or already diagnosed with PsA1 completed the PsAID-12, which guides management. PsAID-12 score >4 indicates an unacceptable symptom state, prompting treatment changes or rheumatology referral.2 Providers received results in real-time for review.
Results: Over 27 months, 7,692 PsO patients were seen by dermatology providers. Of the 6,473 PsO patients without a PsA diagnosis, 37.2% completed the PEST; 12.5% scored ≥3 and completed the PsAID-12. 75.7% of patients who took the PsAID-12 scored ≤4, indicating effective management. Of the 24.3% of patients scoring >4, 24.7% were referred to rheumatology, and 44.4% subsequently received a diagnosis of PsA. When comparing the 493 patients who took the PsAID-12 at least twice, an average baseline PsAID-12 score of 2.80 was seen compared to an average most recent score of 2.53, indicating a significant reduction (P<0.0001).
Conclusion: Our study demonstrates the feasibility of IDEOM's clinical framework in optimizing PsA screening, assessment, and quality of care.

INTRODUCTION

Psoriatic arthritis (PsA) is a prevalent inflammatory condition that requires timely recognition and intervention to prevent long-term disability. In many instances, cutaneous manifestations of psoriasis (PsO) precede the onset of arthritis by 10 to 12 years, positioning dermatologists as the first healthcare providers capable of detecting early signs of joint involvement. Recognizing and addressing PsA in its early stages is essential for optimizing patient outcomes, highlighting the need for increased awareness and collaboration between dermatologists and rheumatologists.1

The Psoriasis Epidemiology Screening Tool (PEST) is a validated, five-question screening tool designed to identify key symptoms associated with PsA. A score of greater than or equal to 3 warrants high suspicion for a PsA diagnosis. Reported sensitivity and specificity values for the PEST vary across studies, with sensitivity ranging from 60% to 94% and specificity from 66% to 78%.2-4 In addition to diagnostic tools, the Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID-12) is a validated patient-reported outcome measure for assessing the impact of PsA symptoms on health-related quality of life. The PsAID-12 includes an established cutoff for a Patient Acceptable Symptom State (PASS), where a score of less than or equal to 4 indicates an "acceptable" symptom state, while a score >4 indicates an "unacceptable" symptom burden.5,6 These tools are essential in both the identification and ongoing assessment of PsA.

While the PEST and PsAID-12 can effectively aid in the diagnosis and assessment of PsA, up to 41% of PsA cases go undiagnosed, suggesting suboptimal implementation of these tools in the clinical setting. To address this gap, the International Dermatology Outcome Measures (IDEOM) group developed a clinical framework using the PEST and PsAID-12 to streamline PsA screening, symptom assessment, and specialist referral.7 This quality improvement (QI) initiative aims to integrate the IDEOM clinical framework into the electronic medical record (EMR) system in order to assess its feasibility and utility in a real-world clinical setting.
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