Psoriasis Epidemiology Screening Tool (PEST)

The Psoriasis Epidemiology Screening Tool (PEST) is a brief, validated questionnaire used to screen for psoriatic arthritis (PsA) in people with psoriasis. It consists of five yes/no questions about joint pain and swelling, heel pain, history of arthritis and finger/toe swelling, plus a simple mannequin to mark affected joints. Each “yes” is scored 1; a total score of 3 or more suggests possible PsA and should prompt further assessment or rheumatology referral.

Early recognition of PsA is crucial, as delayed diagnosis is associated with irreversible joint damage, disability and reduced quality of life. NICE guidance on psoriasis recommends that adults with any type of psoriasis receive an annual assessment for psoriatic arthritis using a validated tool such as PEST. PEST is particularly attractive in busy primary care and dermatology settings because it is short, patient‑completed and does not require laboratory tests or imaging.

Several studies have evaluated the performance of PEST against other PsA screening tools (such as PASE, ToPAS and EARP) across primary and secondary care. Overall, questionnaire‑based tools have moderate accuracy, and no single instrument detects all cases. However, PEST has consistently shown a favourable balance between sensitivity and specificity, and remains one of the most practical options for routine use. A positive PEST score should not be viewed as a diagnosis, but as an indication that a more detailed musculoskeletal assessment (joint examination, history, imaging and inflammatory markers) is warranted.

Clinicians can integrate PEST into annual psoriasis reviews, biologic screening visits, or nurse‑led clinics. Patients can also complete PEST at home (for example, via online forms or paper questionnaires), allowing services to triage those who may benefit from rheumatology referral.

Key references

1. Ibrahim GH et al. Evaluation of an existing screening tool for psoriatic arthritis in people with psoriasis and the development of a new instrument: The Psoriasis Epidemiology Screening Tool (PEST) questionnaire. Clin Exp Rheumatol. 2009;27(3):469–474.

2. Iragorri N et al. Psoriatic arthritis screening: a systematic review and meta‑analysis. Rheumatology (Oxford). 2019;58(4):692–707.

3. Ganatra B et al. Use of a validated screening tool for psoriatic arthritis in psoriasis patients as per NICE guidance. BMJ Open Qual. 2015;4(1):u203335.w2644.

4. Coates LC et al. Assessment of two screening tools to identify psoriatic arthritis in patients with psoriasis (PEST vs CONTEST). J Eur Acad Dermatol Venereol. 2019;33(3):e109–e111.

Reviewed: August 2026

Version ID: 2/PES/AAR/08/26