针对银屑病关节炎的治疗目标：定义反映疾病低活动状态的银屑病关节炎疾病活动评分。
Treating Psoriatic Arthritis to Target: Defining the Psoriatic Arthritis Disease Activity Score That Reflects a State of Minimal Disease Activity.
机构信息
From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network.
出版信息
J Rheumatol. 2020 Mar;47(3):362-368. doi: 10.3899/jrheum.181472. Epub 2019 Jun 15.
OBJECTIVE
The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite disease activity measure (range 0-10) for psoriatic arthritis (PsA). We aimed to validate a cutoff value of PASDAS that defines minimal disease activity (MDA) state, as well as to validate previously defined PASDAS cutoffs for low and high disease activity.
METHODS
Patients were prospectively recruited from the University of Toronto PsA clinic according to a standard protocol, and variables necessary to complete the PASDAS and the MDA were collected. Receiver-operating characteristic (ROC) curve analysis determined the optimal PASDAS cutoff discriminating patients in MDA state from those not in MDA. Previously proposed PASDAS disease activity cutoff scores were validated by determining the proportion of patients requiring treatment escalation, a surrogate of active disease, in each of low, moderate, and high disease activity groups.
RESULTS
One hundred seventy-eight patients [53.9% male, mean PASDAS 3.29 (SD 1.29), 47.8% in MDA] were recruited. ROC curve analysis identified a PASDAS score of 3.2 as the point that maximized the sensitivity and specificity for MDA based on 5 of 7 criteria (sensitivity 88%, specificity 92%, area under the curve 0.96). For MDA based on meeting 6 of 7 and 7 of 7 criteria, PASDAS scores of 2.6 and 2.1 maximized sensitivity and specificity, respectively. An increasing proportion of patients from low to moderate to high disease activity groups required treatment escalation, increasing from 8.1% to 42% to 67%, respectively.
CONCLUSION
A PASDAS score < 3.2 reflects MDA. This study has externally validated PASDAS cutoff scores previously proposed to differentiate between low, moderate, and high disease activity.
目的
银屑病关节炎疾病活动评分（PASDAS）是一种针对银屑病关节炎（PsA）的综合疾病活动衡量标准（范围 0-10）。我们旨在验证 PASDAS 的一个截断值，该截断值定义了最小疾病活动（MDA）状态，并验证先前定义的 PASDAS 截断值，以区分低、中、高疾病活动状态。
方法
根据标准方案，前瞻性地从多伦多大学的 PsA 诊所招募患者，收集完成 PASDAS 和 MDA 所需的变量。接受者操作特征（ROC）曲线分析确定了区分 MDA 状态患者和非 MDA 状态患者的最佳 PASDAS 截断值。通过确定处于低、中、高疾病活动组的每个组中需要治疗升级的患者比例（疾病活跃的替代指标），验证了先前提出的 PASDAS 疾病活动截断评分。
结果
共招募了 178 例患者[53.9%为男性，平均 PASDAS 为 3.29（SD 1.29），47.8%处于 MDA]。ROC 曲线分析确定 PASDAS 得分为 3.2 时，基于 7 项标准中的 5 项（敏感性 88%，特异性 92%，曲线下面积 0.96），MDA 的敏感性和特异性最佳。对于满足 6 项和 7 项标准的 MDA，PASDAS 得分分别为 2.6 和 2.1 时，敏感性和特异性最佳。低、中、高疾病活动组的患者中，需要治疗升级的患者比例逐渐增加，分别为 8.1%、42%和 67%。
结论
PASDAS 评分<3.2 反映了 MDA。本研究对外验证了先前提出的用于区分低、中、高疾病活动的 PASDAS 截断值。
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