Department of Public Health, Henri Mondor Hospital, Université Paris Est Créteil, EA 7376 - CEpiA, Créteil, France.
Department of Rheumatology, Saint Joseph Hospital, Paris, France.
J Eur Acad Dermatol Venereol. 2018 Nov;32(11):1950-1953. doi: 10.1111/jdv.14861. Epub 2018 Mar 9.
Dermatologists are recommended to ask psoriasis patients about musculoskeletal complaints to allow early detection and treatment of psoriatic arthritis (PsA). Screening tools have been developed to help identify patients warranting further rheumatologic assessment, but evidence suggests room for improvement in their diagnostic value and ease of use for outpatient practice.
To develop and internally validate a brief tool for dermatologists to screen patients to refer to a rheumatologist for PsA diagnosis.
After the literature review, 23 items were selected, covering pain at various locations and inflammatory signs of PsA. The validation study was conducted in medically diagnosed psoriasis patients consecutively recruited between 2012 and 2014 (Saint Joseph Hospital, Paris, France). Patients were enrolled by a dermatologist who helped to complete the questionnaire. Diagnosis of PsA was established by a rheumatologist based on CASPAR criteria. Multivariate logistic regression models were performed to build the scale, assessing discrimination through sensitivity, specificity and area under the ROC curve (AUC). Final model was internally validated using bootstrapping techniques.
One hundred and sixty-eight patients were recruited, of whom nine were excluded for known PsA and 21 did not attend the rheumatologist consultation. Of 137 included patients (median age 43 years, 59.6% men), 21 (15.3%) had a PsA diagnosis. Final regression model retained four independent items, including evocative signs of dactylitis, inflammatory heel pain, bilateral buttock pain and peripheral joint pain with swelling in patients aged <50. A total score (the PURE-4) was computed (0-4 points) that demonstrated excellent discriminative power (AUC = 87.6%; Sensitivity = 85.7% and Specificity = 83.6% at the threshold of ≥1/4 points), with no evidence for over-optimism in bootstrapped internal validation.
These findings demonstrate the good diagnostic properties of a new screening scale using only four easy-to-collect items. If confirmed in other populations, it may prove useful in outpatient dermatology clinics for triage of psoriasis patients requiring further assessment by the rheumatologist.
皮肤科医生被建议询问银屑病患者有关肌肉骨骼投诉，以允许早期发现和治疗银屑病关节炎（PsA）。已经开发出筛选工具来帮助识别需要进一步风湿评估的患者，但有证据表明，在其诊断价值和便于门诊实践使用方面仍有改进的空间。
为皮肤科医生开发并内部验证一种用于筛查患者以将其转诊给风湿病医生进行 PsA 诊断的简短工具。
在文献回顾后，选择了 23 个项目，涵盖了各种部位的疼痛和银屑病关节炎的炎症迹象。验证研究于 2012 年至 2014 年期间在医学诊断的银屑病患者中连续进行（巴黎圣约瑟夫医院，法国）。皮肤科医生协助完成问卷后，招募患者。风湿病医生根据 CASPAR 标准建立 PsA 诊断。通过多变量逻辑回归模型构建量表，通过敏感性、特异性和 ROC 曲线下面积（AUC）评估区分度。使用自举技术对内部分数进行内部验证。
共招募了 168 名患者，其中 9 名因已知的 PsA 被排除，21 名患者未参加风湿病医生的咨询。在纳入的 137 名患者中（中位年龄 43 岁，59.6%为男性），21 名（15.3%）患有 PsA 诊断。最终回归模型保留了四个独立的项目，包括指炎的提示性体征、炎性足跟痛、双侧臀部疼痛和 50 岁以下患者的外周关节疼痛伴肿胀。计算了总分（PURE-4）（0-4 分），显示出良好的区分能力（AUC = 87.6%；在≥1/4 分的阈值下，敏感性为 85.7%，特异性为 83.6%），在自举内部验证中没有过度乐观的证据。
这些发现表明，使用仅四个易于收集的项目的新筛选量表具有良好的诊断特性。如果在其他人群中得到证实，它可能有助于在门诊皮肤科诊所对需要进一步由风湿病医生评估的银屑病患者进行分诊。
