将患者报告的结局测量指标相结合，以筛查类风湿关节炎和银屑病关节炎的活动性疾病。
Combining patient-reported outcome measures to screen for active disease in rheumatoid arthritis and psoriatic arthritis.
机构信息
Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands.
Department of Rheumatology, Erasmus MC, Rotterdam, The Netherlands
出版信息
RMD Open. 2024 Oct 18;10(4):e004687. doi: 10.1136/rmdopen-2024-004687.
OBJECTIVES
To investigate whether a combination of general health (Visual Analogue Scale (VAS)), Health Assessment Questionnaire-Disability Index (HAQ-DI), pain (VAS/Numerical Rating Scale (NRS)), quality of life (EQ-5D), fatigue (VAS/NRS) and presenteeism (0%-100% productivity loss) could aid as a screening tool to detect active disease in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA).
METHODS
RA patients from the tREACH trial and TARA trial (n=683) and PsA patients from the DEPAR cohort (n=525) were included. The association of a deterioration in the aforementioned patient-reported outcome measure (PROM) scores between two consecutive visits and having active disease was assessed. Active disease was defined as a change from disease activity score (DAS) ≤2.4 to DAS >2.4 in RA or Disease Activity Index in Psoriatic Arthritis (DAPSA) ≤14 to DAPSA >14 in PsA. The area under the curve (AUC) of the sum score of deteriorated PROMs was evaluated.
RESULTS
4594 RA and 1154 PsA visits were evaluated and active disease occurred in 358 (8%) RA and 177 (15%) PsA visits. In both RA and PsA, a deterioration in general health (VAS), HAQ-DI, EQ-5D and pain (VAS/NRS) was significantly associated with active disease. The combination of these PROMs showed acceptable to excellent discriminative ability (RA AUC=0.76, PsA AUC=0.85). If a cut-point of ≥1 deteriorated PROMs is used, 40% of the visits in which RA patients have remission or low disease activity are correctly specified (specificity of 40%), while 10% of visits with active disease are overlooked (sensitivity of 90%). In PsA, these percentages are 41% and 4%, respectively.
CONCLUSION
A combination of general health, HAQ-DI, EQ-5D and pain could aid as a screening tool for active disease in patients with RA and PsA. These data could help facilitate remote monitoring of RA and PsA patients in the future.
TRIAL REGISTRATION NUMBERS
ISRCTN26791028, NTR2754.
目的
探讨一般健康状况（视觉模拟评分（VAS））、健康评估问卷残疾指数（HAQ-DI）、疼痛（VAS/数字评定量表（NRS））、生活质量（EQ-5D）、疲劳（VAS/NRS）和工作效率（0%-100%生产力损失）的综合评分是否可作为一种筛查工具，以检测类风湿关节炎（RA）和银屑病关节炎（PsA）患者的活动性疾病。
方法
纳入了 tREACH 试验和 TARA 试验中的 RA 患者（n=683）和 DEPAR 队列中的 PsA 患者（n=525）。评估了上述患者报告结局测量（PROM）评分在两次连续就诊之间恶化与活动性疾病之间的关联。活动性疾病定义为 RA 从疾病活动评分（DAS）≤2.4 变为 DAS>2.4 或 PsA 从银屑病关节炎疾病活动指数（DAPSA）≤14 变为 DAPSA>14。评估了恶化的 PROM 综合评分的曲线下面积（AUC）。
结果
评估了 4594 次 RA 和 1154 次 PsA 就诊，358 次（8%）RA 和 177 次（15%）PsA 就诊出现活动性疾病。在 RA 和 PsA 中，一般健康状况（VAS）、HAQ-DI、EQ-5D 和疼痛（VAS/NRS）的恶化均与活动性疾病显著相关。这些 PROM 的组合具有可接受至极好的区分能力（RA AUC=0.76，PsA AUC=0.85）。如果使用≥1 个恶化的 PROMs 的切点，则 RA 患者缓解或低疾病活动的就诊中有 40%可被正确指定（特异性为 40%），而活动性疾病的就诊中有 10%被漏诊（敏感性为 90%）。在 PsA 中，这些百分比分别为 41%和 4%。
结论
一般健康状况、HAQ-DI、EQ-5D 和疼痛的综合评分可作为 RA 和 PsA 患者活动性疾病的筛查工具。这些数据可能有助于未来方便 RA 和 PsA 患者的远程监测。
临床试验注册号
ISRCTN26791028，NTR2754。
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