银屑病关节炎常规临床实践的综合指标：英国多中心研究中简化版本的测试

Composite Measures for Routine Clinical Practice in Psoriatic Arthritis: Testing of Shortened Versions in a UK Multicenter Study.

作者信息

Tillett William, FitzGerald Oliver, Coates Laura C, Packham Jon, Jadon Deepak R, Massarotti Marco, Brook Mel, Lane Suzanne, Creamer Paul, Antony Anna, Korendowych Eleanor, Rambojun Adwaye, McHugh Neil J, Helliwell Philip S

机构信息

As part of the supplement series GRAPPA 2020, this report was reviewed internally and approved by the Guest Editors for integrity, accuracy, and consistency with scientific and ethical standards. This report is independent research funded by the National Institute for Health Research (NIHR), Programme Grants for Applied Research (Early detection to improve outcome in patients with undiagnosed PsA [PROMPT], RP-PG-1212-20007). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. W. Tillett, BSc, MBChB, PhD, FRCP, N.J. McHugh, MBChB, MD, FRCP, FRCPath, Department of Pharmacy and Pharmacology, University of Bath, and Royal National Hospital for Rheumatic Diseases, Bath, UK; O. FitzGerald, MD, FRCPI, FRCP(UK), Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland; L.C. Coates, MB ChB, PhD, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK; J. Packham, DM, FRCP, Haywood Rheumatology Centre, Stoke-on-Trent, UK; D.R. Jadon, MBBCh, MRCP, PhD, University of Cambridge, Cambridge, UK; M. Massarotti, MD, Department of Rheumatology, University Hospitals Dorset NHS Foundation Trust, Christchurch, New Zealand; M. Brook, Patient Resesarch Partner, E. Korendowych, PhD, MRCP, Royal National Hospital for Rheumatic Diseases, Bath, UK; S. Lane, MBChB, MD, FRCP, Ipswich Hospital NHS Trust, Ipswich, UK; P. Creamer, MBChB, North Bristol NHS Foundation Trust, Bristol, UK; A. Antony, MBBS, School of Clinical Sciences, Monash University, Melbourne, Australia; A. Rambojun, PhD, Department of Pharmacy and Pharmacology, University of Bath, Bath, UK; P.S. Helliwell, MD, PhD, Professor of Clinical Rheumatology, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research Leeds Biomedical Research Centre, Leeds, UK. SL has received sponsorship for both the European Alliance of Associations for Rheumatology and the American College of Rheumatology this year, both from AbbieVie, and last year for Madrid from Celgene, but no commercial work for any organizations. All other authors declare no conflicts of interest. Address correspondence to Dr. W. Tillett, Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Coombe Park, Bath, BA1 3NG, UK. Email:

出版信息

J Rheumatol. 2021 Mar 1. doi: 10.3899/jrheum.201675.

DOI:10.3899/jrheum.201675

PMID:33649075

Abstract

OBJECTIVE

To test shortened versions of the psoriatic arthritis (PsA) composite measures for use in routine clinical practice.

METHODS

Clinical and patient-reported outcome measures (PROMs) were assessed in patients with PsA at 3 consecutive follow-up visits in a UK multicenter observational study. Shortened versions of the Composite Psoriatic Arthritis Disease Activity Index (CPDAI) and Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) Composite Exercise (GRACE) measures were developed using PROMs and tested against the Disease Activity Score in 28 joints (DAS28), composite Disease Activity in Psoriatic Arthritis, and Routine Assessment of Patient Index Data (RAPID3). Discrimination between disease states and responsiveness were tested with the -score, standardized response mean (SRM), and effect size (ES). Data were presented to members at the GRAPPA 2020 annual meeting and members voted on the recommended composite routine practice.

RESULTS

The SRM for the GRACE, 3 visual analog scale (VAS), and 4VAS were 0.67, 0.77, and 0.63, respectively, and for CPDAI and shortened CPDAI (sCPDAI) were 0.54 and 0.55, respectively. Shortened versions of the GRACE increased the -score from 7.8 to 8.7 (3VAS) and 9.0 (4VAS), but reduced the -score in the CPDAI/sCPDAI from 6.8 and 6.1. The 3VAS and 4VAS had superior performance characteristics to the sCPDAI, DAS28, Disease Activity in Psoriatic Arthritis, and RAPID3 in all tests. Of the members, 60% agreed that the VAS scales contained enough information to assess disease and response to treatment, 53% recommended the 4VAS for use in routine care, and 26% the 3VAS, while leaving 21% undecided.

CONCLUSION

Shortening the GRACE to VAS scores alone enhances the ability to detect status and responsiveness and has the best performance characteristics of the tested composite measures. GRAPPA members recommend further testing of the 3VAS and 4VAS in observational and trial datasets.

摘要

目的

测试用于常规临床实践的银屑病关节炎（PsA）综合指标的简化版本。

方法

在一项英国多中心观察性研究中，对PsA患者在连续3次随访时的临床和患者报告结局指标（PROMs）进行评估。使用PROMs制定了银屑病关节炎综合疾病活动指数（CPDAI）和银屑病与银屑病关节炎研究与评估小组（GRAPPA）综合运动（GRACE）指标的简化版本，并与28个关节疾病活动评分（DAS28）、银屑病关节炎综合疾病活动度以及患者指数数据常规评估（RAPID3）进行对比测试。通过Z评分、标准化反应均值（SRM）和效应量（ES）来测试疾病状态之间的区分度和反应性。数据在GRAPPA 2020年会上展示给成员，成员们对推荐的综合常规实践进行投票。

结果

GRACE、3个视觉模拟量表（VAS）和4个VAS的SRM分别为0.67、0.77和0.63，CPDAI和简化CPDAI（sCPDAI）的SRM分别为0.54和0.55。GRACE的简化版本将Z评分从7.8提高到8.7（3个VAS）和9.0（4个VAS），但CPDAI/sCPDAI的Z评分从6.8和6.1降低。在所有测试中，3个VAS和4个VAS的性能特征优于sCPDAI、DAS28、银屑病关节炎疾病活动度和RAPID3。在成员中，60%同意VAS量表包含足够信息来评估疾病和治疗反应，53%推荐4个VAS用于常规护理，26%推荐3个VAS，21%未作决定。