Usefulness of the disease activity scores for polymyalgia rheumatica for predicting glucocorticoid dose changes: A study of 243 scenarios
Usefulness of the disease activity scores for polymyalgia rheumatica for predicting glucocorticoid dose changes: A study of 243 scenarios
复制标题
DOI：
10.1002/art.22630
复制
发表时间：
2007-04-15
期刊：
影响因子：
--
通讯作者：
Saraux, Alain
中科院分区：
文献类型：
--
作者：
Binard, Aymeric;De Bandt, Michel;Saraux, Alain
Objective.评估风湿性多肌痛（PMR）患者糖皮质激素剂量变化与PMR活动评分（PMR-AS）及其组成部分之间的相关性。PMR的9个临床小插曲由一个专家小组撰写，并提交给35名风湿病学家，他们被要求使用视觉模拟量表（VASph）评估疾病活动，并确定是否有PMR复发需要增加糖皮质激素剂量。在7个小插曲中，>80%的风湿病学家同意复发的诊断，证明糖皮质激素剂量决定是合理的。共获得243个插图-医生组合。利用这些小插曲，我们评估了增加糖皮质激素剂量的决定与PMR AS值及其组分之间的统计学关联。（VASph、疼痛视觉模拟量表[VASp]、C-反应蛋白水平[CRP]、晨僵[MST]和上肢抬高[EUL]），或最近2次访视之间这些变量的差异（dPMR-AS、dVASph、dVASp、dCRP、dMST和dEUL）。决定增加糖皮质激素剂量的最强关联发生在dPMR-AS >4.2、dMST >10分钟、dVASph >1.55和dCRP >4 mg/dl（所有4个变量的灵敏度为99.3%，特异性为100%）; MST >= 10分钟（100%灵敏度，99.3%特异性）; PMR-AS >= 7（98.1%灵敏度，94.3%特异性）; VASph >= 2.25 CRP ≥ 14.5 mg/L（敏感性66.3%，特异性99.3%）。尽管VASph存在个体间差异，但PMR-AS是疾病活动的良好指标。然而，MST、dMST、dVASph、dPMR-AS和dCRP的表现优于PMR-AS。这些变量可能有助于根据每个患者的个体需要调整糖皮质激素剂量。
Objective. To evaluate associations linking glucocorticoid dose changes in patients with polymyalgia rheumatica (PMR) to the PMR activity score (PMR-AS) and its components.Methods. Nine clinical vignettes of PMR were written by a panel of experts and submitted to 35 rheumatologists, who were asked to assess disease activity using a visual analog scale (VASph) and to determine whether there was a relapse of PMR requiring an increase in the glucocorticoid dose. In 7 vignettes, >80% of the rheumatologists agreed on the diagnosis of relapse justifying the glucocorticoid dose decision. A total of 243 vignette-physician combinations were obtained. Using these vignettes, we evaluated statistical associations linking a decision to increase the glucocorticoid dose to the value of PMR-AS, of its components (VASph, visual analog scale for pain [VASp], C-reactive protein level [CRP], morning stiffness [MST], and elevation of upper limbs [EUL]), or to the difference in these variables between the last 2 visits (dPMR-AS, dVASph, dVASp, dCRP, dMST, and dEUL).Results. The strongest associations with a decision to increase the glucocorticoid dose occurred with dPMR-AS >4.2, dMST >10 minutes, dVASph >1.55, and dCRP >4 mg/dl (99.3% sensitivity, 100% specificity for all 4 variables); MST >= 10 minutes (100% sensitivity, 99.3% specificity); PMR-AS >= 7 (98.1% sensitivity, 94.3% specificity); VASph >= 2.25 (94.2% sensitivity, 83.6% specificity); and CRP level >= 14.5 mg/liter (66.3% sensitivity, 99.3% specificity).Conclusion. Despite inter-individual variations in VASph, PMR-AS was a good indicator of disease activity. However, MST, dMST, dVASph, dPMR-AS, and dCRP performed better than PMR-AS. These variables may be useful in tailoring the glucocorticoid dose to the individual needs of each patient.