Gladman D D, Schentag C T, Tom B D M, Chandran V, Brockbank J, Rosen C, Farewell V T
Toronto Western Research Institute, Psoriatic Arthritis Program, Centre for Prognosis Studies in The Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
Ann Rheum Dis. 2009 Apr;68(4):497-501. doi: 10.1136/ard.2008.089441. Epub 2008 Apr 29.
To develop and validate a psoriatic arthritis (PsA) screening questionnaire: the Toronto Psoriatic Arthritis Screen (ToPAS).
The ToPAS was developed through review of items seen in patients with PsA and evaluation by patients with PsA and patients with other rheumatological conditions, and was administered to consecutive consenting patients attending five clinics: PsA, psoriasis, general dermatology, general rheumatology (excluding PsA patients) and family medicine. All patients were assessed by a rheumatologist according to a standard protocol. A three-step analysis strategy was adopted: a stepwise logistic regression to identify the questions most important in discriminating between those with and without PsA; a logistic model was fitted to three clinically relevant domains for PsA: skin, joints and nails; and a simpler weighting of each of the domains used in step 2. Receiver operating characteristic (ROC) curves were obtained based on these various models.
In all, there were 134 patients from the PsA clinic, 123 with psoriasis, 118 from dermatology, 135 from rheumatology and 178 from family medicine. A simplified discriminatory score based on the skin, joint and nail domains gave results comparable to other methods with an observed overall sensitivity and specificity, based on a single cut point, of 86.8% and 93.1%. When the patients with PsA were compared with each of the other four patient groups individually, the sensitivity and specificity of the ToPAS were: psoriasis 89.1%, 86.3%; dermatology 91.9%, 95.2%; rheumatology 92.6%, 85.7%; and family medicine 90.4%, 100%.
Our simplified index is very good at classifying those who are not diagnosed with PsA and those who are diagnosed with PsA.
开发并验证一种银屑病关节炎（PsA）筛查问卷：多伦多银屑病关节炎筛查量表（ToPAS）。
通过回顾PsA患者的相关条目，并经PsA患者以及其他风湿性疾病患者评估，开发出ToPAS，并将其应用于五家诊所连续同意参与的患者：PsA诊所、银屑病诊所、普通皮肤科诊所、普通风湿科诊所（不包括PsA患者）以及家庭医学诊所。所有患者均由风湿病专家按照标准方案进行评估。采用三步分析策略：进行逐步逻辑回归以确定区分有无PsA最重要的问题；针对PsA的三个临床相关领域（皮肤、关节和指甲）拟合逻辑模型；对第二步中使用的每个领域进行更简单的加权。基于这些不同模型获得受试者操作特征（ROC）曲线。
PsA诊所共有134例患者，银屑病诊所123例，皮肤科诊所118例，风湿科诊所135例，家庭医学诊所178例。基于皮肤、关节和指甲领域的简化鉴别评分结果与其他方法相当，基于单个切点观察到的总体敏感性和特异性分别为86.8%和93.1%。将PsA患者与其他四个患者组分别进行比较时，ToPAS的敏感性和特异性分别为：银屑病组89.1%、86.3%；皮肤科组91.9%、95.2%；风湿科组92.6%、85.7%；家庭医学组90.4%、100%。
我们的简化指标在区分未诊断为PsA的患者和已诊断为PsA的患者方面表现出色。
