P.S. Helliwell, Professor of Clinical Rheumatology, MA, DM, PhD, R. Waxman, Research Coordinator, MPH, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK;
W. Tillett, Consultant Rheumatologist, MBChB, PhD, Department of Pharmacy and Pharmacology, University of Bath, and Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK.
J Rheumatol. 2021 Aug;48(8):1268-1271. doi: 10.3899/jrheum.201317. Epub 2021 Feb 15.
Evaluation of a psoriatic arthritis (PsA), multidimensional, patient-completed disease flare questionnaire (FLARE).
The FLARE questionnaire was administered to 139 patients in a prospective observational study. The "gold standard" of flare was based on patient opinion. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC). Disease activity was measured by the Psoriatic Arthritis Disease Activity Score (PASDAS), Group for Research and Assessment of Psoriasis and PsA (GRAPPA) Composite Exercise (GRACE), Composite Psoriatic Disease Activity Index (CPDAI), and Disease Activity Index for Psoriatic Arthritis (DAPSA).
The most common symptoms of a PsA flare were musculoskeletal, followed by fatigue, frustration, loss of function, and an increase in cutaneous symptoms. The test-retest ICC for the FLARE questionnaire was 0.87 (95% CI 0.72-0.94). The optimum cut-off to identify a flare of disease was 4/10 (sensitivity 0.82, specificity 0.76; area under the curve 0.85). For those patients scoring ≥ 4, the mean score for the composite measures was as follows (score for those not reporting a flare in parentheses): PASDAS 5.3 ± 1.3 (3.1 ± 1.6); GRACE 4.5 ± 1.2 (2.2 ± 1.4); CPDAI 8.9 ± 2.5 (4.7 ± 3.1); and DAPSA 38.2 ± 20.3 (16.8 ± 14.9). In a new flare, the increase in composite measure score was calculated as follows: 1 for PASDAS and GRACE, 2 for CPDAI, and 7 for DAPSA. Agreement between the definition of flare using the cut-off of 4 from the questionnaire, and that indicated by the subject in a separate, standalone question was 0.57 (Cohen κ).
A PsA flare displays escalation of symptoms and signs across multiple domains. The FLARE questionnaire has external validity in terms of both composite disease activity and overall patient opinion about the state of their condition.
评估一种多维度、患者自评的银屑病关节炎（PsA）疾病发作问卷（FLARE）。
在一项前瞻性观察研究中，139 名患者接受了 FLARE 问卷的评估。疾病发作的“金标准”基于患者的意见。采用组内相关系数（ICC）评估重测信度。采用银屑病关节炎疾病活动评分（PASDAS）、银屑病关节炎研究与评估组（GRAPPA）综合运动（GRACE）、综合银屑病疾病活动指数（CPDAI）和银屑病关节炎疾病活动指数（DAPSA）评估疾病活动度。
PsA 发作最常见的症状是肌肉骨骼，其次是疲劳、沮丧、功能丧失和皮肤症状加重。FLARE 问卷的重测 ICC 为 0.87（95%置信区间 0.72-0.94）。识别疾病发作的最佳截断值为 4/10（敏感性 0.82，特异性 0.76；曲线下面积 0.85）。对于评分≥4 的患者，复合指标的平均评分如下（括号内为未报告疾病发作的评分）：PASDAS 5.3±1.3（3.1±1.6）；GRACE 4.5±1.2（2.2±1.4）；CPDAI 8.9±2.5（4.7±3.1）；和 DAPSA 38.2±20.3（16.8±14.9）。在新的发作中，复合测量评分的增加计算如下：PASDAS 和 GRACE 为 1，CPDAI 为 2，DAPSA 为 7。问卷中使用 4 分截断值定义的发作与患者在单独的独立问题中表示的发作之间的一致性为 0.57（Cohen κ）。
PsA 发作表现为多个领域症状和体征的加重。FLARE 问卷在复合疾病活动度和患者对自身病情的整体看法方面具有外部有效性。
