Classification criteria for psoriatic arthritis - Development of new criteria from a large international study
Classification criteria for psoriatic arthritis - Development of new criteria from a large international study
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DOI：
10.1002/art.21972
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发表时间：
2006-08-01
影响因子：
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通讯作者：
Mielants, Herman
中科院分区：
文献类型：
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作者：
Taylor, William;Gladman, Dafna;Mielants, Herman
目标。比较现有银屑病关节炎（PsA）分类标准的诊断准确性，并根据观察数据构建新的分类标准。从患有PsA和其他炎性关节病的连续临床参与者中前瞻性地收集数据。受试者按7项标准进行分类。采用条件logistic回归分析比较敏感性和特异性。使用潜在分类分析来计算标准的准确性，以确认临床诊断的有效性作为“病例”性的金标准定义。分类和回归树方法和逻辑回归用于确定新标准的项目，然后使用接收者工作特征曲线构建新标准。收集了588例和536例对照患者的数据，包括类风湿关节炎（384例）、强直性脊柱炎（72例）、未分化关节炎（38例）、结缔组织疾病（14例）和其他疾病（28例）。每组标准的特异性都很高。Vasey和Espinoza方法的敏感性（0.97）与McGonagle等人的方法（0.98）相似，高于Bennett（0.44）、Moll和Wright（0.91）、European Spoudylarthropathy Study Group（0.74）和Gladman等人（0.91）的方法。CASPAR（银屑病关节炎分类标准）标准包括确定的炎性关节疾病，至少从以下特征中获得3分：当前的银屑病(评分为2分；所有其他特征的评分为1)、牛皮癣病史（除非当前有牛皮癣）、牛皮癣家族史（除非当前有牛皮癣或有牛皮癣病史）、指突炎、关节旁新骨形成、类风湿因子阴性和指甲营养不良。与Vasey和espinoza相比，这些标准特异性更高（0.987比0.960），敏感性较低（0.914比0.972）。CASPAR标准简单，特异性高，但敏感度低于Vasey和Espinoza标准。
Objective. To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis (PsA) and to construct new criteria from observed data.Methods. Data were collected prospectively from consecutive clinic attendees with PsA and other inflammatory arthropathies. Subjects were classified by each of 7 criteria. Sensitivity and specificity were compared using conditional logistic regression analysis. Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold standard definition of "case"-ness. Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria, which were then constructed using a receiver operating characteristic curve.Results. Data were collected on 588 cases and 536 controls with rheumatoid arthritis (n = 384), ankylosing spondylitis (n = 72), undifferentiated arthritis (n = 38), connective tissue disorders (n = 14), and other diseases (n = 28). The specificity of each set of criteria was high. The sensitivity of the Vasey and Espinoza method (0.97) was similar to that of the method of McGonagle et al (0.98) and greater than that of the methods of Bennett (0.44), Moll and Wright (0.91), the European Spoudylarthropathy Study Group (0.74), and Gladman et al (0.91). The CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria consisted of established inflammatory articular disease with at least 3 points from the following features: current psoriasis (assigned a score of 2; all other features were assigned a score of 1), a history of psoriasis (unless current psoriasis was present), a family history of psoriasis (unless current psoriasis was present or there was a history of psoriasis), dactylitis, juxtaarticular new bone formation, rheumatoid factor negativity, and nail dystrophy. These criteria were more specific (0.987 versus 0.960) but less sensitive (0.914 versus 0.972) than those of Vasey and Espinoza.Conclusion. The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria.