Queen's University Medical School, Kingston, Ontario, Canada.
Women's College Hospital and University of Toronto, Toronto, Ontario, Canada.
Arthritis Care Res (Hoboken). 2022 Aug;74(8):1254-1262. doi: 10.1002/acr.24570. Epub 2022 May 24.
We undertook this study to identify the optimal combination of triage methods to identify psoriatic arthritis (PsA) among psoriasis patients with musculoskeletal symptoms in a rapid access clinic and to describe their outcome after 1 year.
Patients with psoriasis and no prior diagnosis of PsA were referred for assessment of their musculoskeletal symptoms. Each patient was assessed by the following 3 triage modalities: 1) assessment by an advanced practice physical therapist; 2) targeted musculoskeletal ultrasound (MSK-US); and 3) PsA screening questionnaires. The patients were then evaluated by a rheumatologist who determined the patient's disease status and classified them into the following groups: not PsA, possibly PsA, or PsA. Patients returned for a 1-year follow-up visit and were reassessed for change in their disease status. Sensitivity and specificity were calculated for each individual modality, as well as for combinations of modalities.
A total of 203 patients with psoriasis and musculoskeletal symptoms were enrolled. The percentage of patients classified as having PsA was 8.8%, and 23.6% were converted into the possibly PsA group. There was no significant difference in the individual performance of the modalities. The highest sensitivity was seen with MSK-US (89%), and the highest specificity was found with the Psoriatic Arthritis Screening and Evaluation questionnaire (79%). The addition of MSK-US data improved the performance of the modalities. A total of 9 patients were classified into the PsA group after 1 year. All patient-reported outcome measures had significantly improved at 1 year (P < 0.001).
Combining MSK-US with a screening questionnaire for PsA improved the triage of patients with suspected PsA.
我们开展这项研究旨在确定在快速就诊诊所中，用于识别患有肌肉骨骼症状的银屑病患者中出现的银屑病关节炎（PsA）的最佳分诊方法组合，并描述他们在 1 年后的结局。
患有银屑病且无先前银屑病关节炎诊断的患者被转介来评估其肌肉骨骼症状。每位患者均由以下 3 种分诊方式进行评估：1）高级执业物理治疗师评估；2）靶向肌肉骨骼超声（MSK-US）；3）银屑病关节炎筛查问卷。然后，患者由风湿病医生进行评估，以确定患者的疾病状况并将其分为以下几类：不是银屑病关节炎、可能是银屑病关节炎或银屑病关节炎。患者返回进行为期 1 年的随访，并重新评估其疾病状况的变化。计算了每种单独方法的敏感性和特异性，以及方法组合的敏感性和特异性。
共纳入了 203 例患有银屑病和肌肉骨骼症状的患者。被归类为患有银屑病关节炎的患者比例为 8.8%，23.6%的患者归入可能患有银屑病关节炎的组。各种方法的单独表现没有差异。MSK-US 的敏感性最高（89%），而 Psoriatic Arthritis Screening and Evaluation 问卷的特异性最高（79%）。增加 MSK-US 数据可提高方法的性能。共有 9 例患者在 1 年后被归类为银屑病关节炎组。所有患者报告的结局指标在 1 年后均显著改善（P <0.001）。
将 MSK-US 与银屑病关节炎筛查问卷相结合可改善疑似银屑病关节炎患者的分诊。
