中轴型银屑病关节炎中的难治性概念：对一大组患者中 2 种潜在定义的分析。一项横断面研究。

Difficult-to-Treat Concept in Psoriatic Arthritis: Analysis of 2 Potential Definitions in a Large Group of Patients. A Cross-Sectional Study.

机构信息

F.M. Perrotta, MD, PhD, S. Scriffignano, MD, E. Lubrano, MD, PhD, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio," Università degli Studi del Molise, Campobasso;

S. Gentileschi, MD, R. Terribili, MD, E. Bianchi, MD, B. Frediani, MD, Rheumatology Unit, Dipartimento di Medicina, Chirurgia e Neuroscienze, Università degli Studi di Siena, Siena, Italy.

出版信息

J Rheumatol. 2024 Oct 1;51(10):985-990. doi: 10.3899/jrheum.2024-0101.

DOI:10.3899/jrheum.2024-0101

PMID:39009395

Abstract

OBJECTIVE

The main aim of the study was to evaluate the performance of 2 proposed criteria for difficult-to-treat (D2T) psoriatic arthritis (PsA) in a group of patients and to evaluate the agreement between the 2 sets of criteria.

METHODS

We performed a cross-sectional analysis of 2 longitudinal cohorts of patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis (CASPAR), with at least 1 year of follow-up. A detailed medical history was collected and a physical examination was performed for all recruited patients. The proposed criteria for patients with D2T PsA were applied in our group. To test the performance of the 2 sets of criteria, we used an external validator (absence of patient acceptable symptom state + physician global assessment ≥ 6 cm). Finally, the agreement between the 2 sets of criteria was assessed.

RESULTS

We evaluated 378 patients with PsA (219 male/159 female), with a mean age (range) of 58 (19-75) years. Seventy-five (19.8%) patients fulfilled the D2T criteria proposed by Perrotta et al and 58 (15.3%) the D2T criteria proposed by Kumthekar et al. Both criteria showed comparable performance, with low sensitivity (Perrotta: 37.8%, Kumthekar: 29.7%) but good specificity (Perrotta: 82.1%, Kumthekar: 86.2%). Finally, the agreement between the 2 sets of criteria is substantial (Fleiss [Formula: see text] 0.72), suggesting that both criteria identify nearly the same group of patients.

CONCLUSION

Our study compared 2 published sets of criteria showing comparable performance and substantial agreement. This study may pave the way for further research in this field.

摘要

目的

本研究的主要目的是评估 2 种用于治疗困难（D2T）银屑病关节炎（PsA）的标准在一组患者中的表现，并评估这两种标准之间的一致性。

方法

我们对满足银屑病关节炎分类标准（CASPAR）的 2 个纵向队列的患者进行了横断面分析，这些患者的随访时间至少为 1 年。对所有纳入的患者进行详细的病史采集和体格检查。我们在该组患者中应用了用于 D2T PsA 的标准。为了测试这两种标准的性能，我们使用了外部验证器（患者可接受的症状状态缺失+医生总体评估≥6cm）。最后，评估了这两种标准之间的一致性。

结果

我们评估了 378 名患有 PsA 的患者（219 名男性/159 名女性），平均年龄（范围）为 58（19-75）岁。75 名（19.8%）患者符合 Perrotta 等人提出的 D2T 标准，58 名（15.3%）患者符合 Kumthekar 等人提出的 D2T 标准。这两种标准的性能相似，敏感性较低（Perrotta：37.8%，Kumthekar：29.7%），但特异性较好（Perrotta：82.1%，Kumthekar：86.2%）。最后，这两种标准之间的一致性是显著的（Fleiss [Formula: see text] 0.72），这表明这两种标准几乎识别了相同的患者群体。