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Psoriatic arthritis — SCE Rheumatology MCQ

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ModerateSpondyloarthropathiesPsoriatic arthritisSCE Rheumatology

A 53-year-old woman with psoriatic arthritis has psoriasis severe enough to require systemic treatment. Her joint and skin disease have been assessed, and she has no gastrointestinal or ocular symptoms. Her records show no previous structured comorbidity assessment. Which additional screening assessment should be offered now and repeated at least every 5 years?

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Correct answer: E — Cardiovascular risk assessment using a validated risk tool

The correct answer is E. Psoriasis requiring systemic treatment meets the NICE definition of severe psoriasis. NICE recommends a validated cardiovascular risk assessment at presentation and at least every 5 years because severe psoriasis is associated with increased cardiovascular risk. Psoriatic arthritis adds a further inflammatory and cardiometabolic risk burden. The assessment should identify modifiable factors such as hypertension, dyslipidaemia, diabetes, smoking and obesity. Inflammatory bowel disease and ocular inflammation are recognised associations of psoriatic arthritis, but faecal calprotectin and slit-lamp examinations are not recommended as routine screening in asymptomatic adults. Neither routine urine albumin-to-creatinine ratio testing for a specific psoriatic nephropathy nor universal DXA at fixed 5-year intervals is recommended solely because the patient has psoriatic disease.

Reference: National Institute for Health and Care Excellence. Psoriasis, Quality Standard QS40, Quality statement 4: Assessing cardiovascular risk. 2013; based on NICE CG153, updated 2017. https://www.nice.org.uk/guidance/qs40/chapter/quality-statement-4-assessing-cardiovascular-risk