与银屑病关节炎患者疾病影响程度低相关的疾病特征：一项横断面多中心研究的结果。
Disease features associated with a low disease impact in patients with psoriatic arthritis: results of a cross-sectional multicenter study.
机构信息
Department of Rheumatology, HU. Central de Asturias, Avenida de Roma s/n, 33011, Oviedo, Spain.
Department of Rheumatology, HU. Clinic and IDIBAPS, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
出版信息
Arthritis Res Ther. 2020 Apr 15;22(1):82. doi: 10.1186/s13075-020-02168-1.
BACKGROUND
Patient-reported outcomes measures, such as those provided by the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, have been found to be a reliable indicator of change during treatment, predictive of long-term outcomes, and the impact of psoriatic arthritis (PsA) on patients' lives. The objective of the study was to describe the demographic and clinical characteristics of PsA patients with a low disease impact and to analyze predictive factors for that state.
METHODS
Post hoc analysis of a cross-sectional multicenter study that included 223 consecutive patients. PsAID questionnaire was used to estimate disease impact. Patients with a PsAID < 4 were considered in low disease impact. Minimal disease activity (MDA) response and the Health Assessment Questionnaire (HAQ) were also assessed. The degree of agreement between the different outcomes was addressed by Cohen's kappa index.
RESULTS
One hundred and twenty-two (54.7%) patients reached a PsAID < 4. Among them, 52.0% and 68.0% presented articular or skin remission, respectively. Almost 75% of patients were in MDA state and 85.2% presented a low disability state according to the HAQ. A moderate concordance between HAQ ≤ 0.5 and PsAID < 4 (k = 0.53), fair between MDA and PsAID < 4 (k = 0.36), and moderate between DAPSA remission and PsAID < 4 (k = 0.46) was observed. Multivariate logistic regression analysis showed that patients with distal interphalangeal joint (DIP) disease (OR 0.40, 95%CI, 0.20-0.79, p = 0.009), family history of PsA (OR 0.25, 95%CI, 0.09-0.72, p = 0.010), and higher C-reactive protein (OR 0.92, 95%CI, 0.85-0.99, p = 0.036) were significantly less likely to reach a PsAID < 4.
CONCLUSIONS
There is certain discrepancy between disease activity measures and a low impact of disease in PsA. Clinical features (DIP joint involvement), biologic activity, and genetic factors (familial history) seem to be associated with lower odds of reaching a low disease impact.
背景
患者报告的结局测量指标，如银屑病关节炎疾病影响量表（PsAID）提供的指标，已被证明是治疗过程中变化的可靠指标，可预测长期结局以及银屑病关节炎（PsA）对患者生活的影响。本研究的目的是描述疾病影响程度低的 PsA 患者的人口统计学和临床特征，并分析该状态的预测因素。
方法
这是一项横断面多中心研究的事后分析，共纳入 223 例连续患者。采用 PsAID 问卷评估疾病影响。PsAID<4 的患者被认为疾病影响程度低。还评估了最小疾病活动（MDA）反应和健康评估问卷（HAQ）。通过 Cohen's kappa 指数来评估不同结局之间的一致性程度。
结果
122 例（54.7%）患者的 PsAID<4。其中，分别有 52.0%和 68.0%的患者存在关节或皮肤缓解。近 75%的患者处于 MDA 状态，85.2%的患者根据 HAQ 呈现低残疾状态。HAQ≤0.5 与 PsAID<4 之间存在中度一致性（k=0.53），MDA 与 PsAID<4 之间存在适度一致性（k=0.36），DAPSA 缓解与 PsAID<4 之间存在中度一致性（k=0.46）。多变量逻辑回归分析显示，存在远端指间关节（DIP）疾病的患者（OR 0.40，95%CI，0.20-0.79，p=0.009）、有 PsA 家族史的患者（OR 0.25，95%CI，0.09-0.72，p=0.010）和较高的 C 反应蛋白（OR 0.92，95%CI，0.85-0.99，p=0.036）的患者不太可能达到 PsAID<4。
结论
在 PsA 中，疾病活动度测量指标与疾病的低影响之间存在一定差异。临床特征（DIP 关节受累）、生物活性和遗传因素（家族史）似乎与较低的疾病低影响几率相关。
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