Academic Unit of Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Ann Rheum Dis. 2013 Jun;72(6):986-91. doi: 10.1136/annrheumdis-2012-201341. Epub 2012 Jul 13.
To develop new composite disease activity indices for psoriatic arthritis (PsA).
Data from routine clinic visits at multiple centres were collected in a systematic manner. Data included all domains identified as important in randomised controlled trials in PsA. Decisions to change treatment were used as surrogates for high disease activity. New indices were developed by multiple linear regression (psoriatic arthritis disease activity score: PASDAS) and empirically, utilising physician-defined cut-offs for disease activity (arithmetic mean of desirability functions: AMDF). These were compared with existing composite measures: Composite Psoriatic arthritis Disease Activity Index (CPDAI), Disease Activity for PSoriatic Arthritis (DAPSA), and Disease Activity Score for rheumatoid arthritis (DAS28).
161/503 (32%) subjects had treatment changes. Although all measures performed well, compared with existing indices, PASDAS was better able to discriminate between high and low disease activity (area under receiver operating curves (ROC)) curve with 95% CI: PASDAS 0.773 (0.723, 0.822); AMDF 0.730 (0.680, 0.780); CPDAI 0.719 (0.668, 0.770); DAPSA 0.710 (0.654, 0.766); DAS28 0.736 (0.680, 0.792). All measures were able to discriminate between disease activity states in patients with oligoarthritis, although area under the receiver operating curves (AUC) were generally smaller. In patients with severe skin disease (psoriasis area and severity index>10) both nonparametric and AUC curve statistics were nonsignificant for all measures.
Two new composite measures to assess disease activity in PsA have been developed. Further testing in other datasets, including comparison with existing measures, is required to validate these instruments.
为银屑病关节炎（PsA）开发新的综合疾病活动指数。
以系统的方式收集来自多个中心常规就诊时的数据。数据包括在 PsA 的随机对照试验中被确定为重要的所有领域。改变治疗的决定被用作疾病高度活动的替代指标。通过多元线性回归（银屑病关节炎疾病活动评分：PASDAS）和经验上利用医师定义的疾病活动截断值（理想函数的算术平均值：AMDF）开发新指数。将这些与现有的综合指标进行比较：复合银屑病关节炎疾病活动指数（CPDAI）、银屑病关节炎疾病活动（DAPSA）和类风湿关节炎疾病活动评分（DAS28）。
161/503（32%）名患者有治疗改变。尽管所有指标都表现良好，但与现有指数相比，PASDAS 能够更好地区分高和低疾病活动（接收者操作特征曲线下面积（ROC）的 95%CI）：PASDAS 0.773（0.723，0.822）；AMDF 0.730（0.680，0.780）；CPDAI 0.719（0.668，0.770）；DAPSA 0.710（0.654，0.766）；DAS28 0.736（0.680，0.792）。所有指标都能够区分寡关节炎患者的疾病活动状态，尽管接收者操作特征曲线下面积（AUC）通常较小。在严重皮肤疾病（银屑病面积和严重程度指数>10）患者中，所有指标的非参数和 AUC 曲线统计均无显著性。
已经开发了两种新的综合措施来评估 PsA 的疾病活动。需要在其他数据集（包括与现有指标的比较）中进行进一步测试，以验证这些工具。
