Cross-cultural adaptation and preliminary diagnostic performance assessment of the psoriasis epidemiology screening tool (PEST) questionnaire in Spanish.
To perform the cross-cultural adaptation of the Psoriasis Epidemiology Screening Tool (PEST) questionnaire into Spanish (PEST-S) and conduct a preliminary exploratory assessment of its discriminative ability to identify psoriatic arthritis (PsA) among patients with psoriasis (Ps), osteoarthritis (OA), or both.
Methods
The PEST questionnaire was translated and culturally adapted into Spanish following international guidelines. A cross-sectional study was conducted including adult patients with PsA, Ps, OA, and Ps+OA. The PEST-S was administered to all participants. PsA diagnosis was confirmed using CASPAR criteria. Diagnostic performance was evaluated using sensitivity, specificity, likelihood ratios, area under the ROC curve (AUC), and Cohen's kappa coefficient. Comparisons of individual PEST-S items were performed across diagnostic groups.
Results
A total of 124 patients were included: 32 with PsA, 31 with Ps, 33 with Ps+OA, and 28 with OA. The questionnaire required less than one min to complete. PEST-S scores ≥3 yielded a sensitivity of 100%, specificity of 94.2%, LR+ of 17.2, and LR- of 0. The AUC was 0.97 (95% CI: 0.95-0.99). Agreement between PEST-S and CASPAR classification was 93.2% (κ = 0.838). A statistically significant difference was found in the responses to all five PEST-S items between patients with PsA and those in the other diagnostic groups (p< 0.05).
Conclusion
The Spanish version of the PEST questionnaire (PEST-S) demonstrated excellent diagnostic performance in distinguishing PsA from Ps and OA in a Spanish-speaking population. These findings support its clinical utility and justify further validation in a screening context among patients with psoriasis without prior rheumatologic evaluation.
