Department of Rheumatology, St Vincent's University Hospital, Elm Park, Dublin, 4, Ireland.
Ann Rheum Dis. 2013 May;72(5):736-40. doi: 10.1136/annrheumdis-2012-201706. Epub 2012 Jun 23.
The objectives of this study were to: (1) assess the prevalence of psoriatic arthritis (PsA) among Psoriasis (Ps) patients attending dermatology clinics; (2) identify clinical predictors of the development of PsA; and (3) compare the performance of three PsA screening questionnaires: Psoriatic Arthritis Screening and Evaluation (PASE), Psoriasis Epidemiology Screening Tool (PEST) and Toronto Psoriatic Arthritis Screening (ToPAS).
Patients were divided into two groups: Group-1, consecutive psoriasis patients attending dermatology clinics with no known diagnosis of inflammatory arthritis and Group-2, consecutive patients attending rheumatology clinics with a confirmed diagnosis of PsA. In Group-1, patients completed the screening questionnaires, followed by a full rheumatological evaluation whether or not they reported musculoskeletal symptoms.
200 patients were recruited with 100 in each group. In all, 84% of patients in dermatology group were using systemic therapy for their skin disease, and 99% of patients in rheumatology group were on systemic immunosuppressives. In Group-1, 29% of patients were diagnosed with PsA after rheumatological evaluation. On univariate and multivariate analyses, there was a significant positive association between Psoriasis Area and Severity Index and a new diagnosis of PsA (p=0.046). Different patterns of joint involvement were noted in patients with newly diagnosed PsA versus patients with established PsA with fewer polyarticular disease presentations (p=0.0001). In Group-1, the PEST, PASE and ToPAS assessments had sensitivities of 27.5%, 24% and 41%, and specificities of 98%, 94% and 90%, respectively. In Group-2, the sensitivities were 86%, 62% and 83%, respectively.
29% of Ps patients attending dermatology clinics had undiagnosed PsA. Psoriasis severity was associated with a new diagnosis of PsA. Poor sensitivities for the screening questionnaires were noted due to inadequate detection of patterns of arthritis other than polyarticular disease.
本研究的目的是：（1）评估皮肤科就诊的银屑病（Ps）患者中银屑病关节炎（PsA）的患病率；（2）确定发展为 PsA 的临床预测因素；（3）比较三种 PsA 筛查问卷的性能：银屑病关节炎筛查和评估（PASE）、银屑病流行病学筛查工具（PEST）和多伦多银屑病关节炎筛查（ToPAS）。
患者分为两组：第 1 组，连续在皮肤科诊所就诊且无已知炎症性关节炎诊断的银屑病患者；第 2 组，连续在风湿病诊所就诊且确诊为 PsA 的患者。在第 1 组中，患者完成了筛查问卷，无论是否报告了肌肉骨骼症状，都进行了全面的风湿病评估。
共招募了 200 名患者，每组 100 名。皮肤科组中，84%的患者使用全身治疗皮肤疾病，风湿病组中，99%的患者使用全身免疫抑制剂。在第 1 组中，29%的患者在风湿病评估后被诊断为 PsA。单因素和多因素分析显示，银屑病面积和严重程度指数与新诊断的 PsA 呈显著正相关（p=0.046）。新诊断的 PsA 患者与已确诊的 PsA 患者的关节受累模式不同，多发性关节疾病表现较少（p=0.0001）。在第 1 组中，PEST、PASE 和 ToPAS 评估的敏感性分别为 27.5%、24%和 41%，特异性分别为 98%、94%和 90%。在第 2 组中，敏感性分别为 86%、62%和 83%。
29%的皮肤科就诊的 Ps 患者患有未确诊的 PsA。银屑病严重程度与新诊断的 PsA 相关。由于未能充分检测到除多发性关节疾病以外的关节炎模式，筛查问卷的敏感性较低。
