目的:银屑病通常先于银屑病关节炎(PsA)的发作,因此,皮肤科医生经常面临的挑战是早期识别银屑病患者的PsA体征。我们的目的是验证PURE-4问卷的西班牙语版本作为PsA的筛选工具,根据灵敏度评估其性能,特异性,可行性,可靠性,和构建有效性。
方法:这是一个横截面,观察,成人银屑病患者的多中心试验。最初,皮肤科医生对患者进行了评估,并完成了PURE-4问卷的2个自给版本(印刷版和在线版).之后,风湿病学家,对PURE-4结果视而不见,评估PsA的存在/不存在,作为确定PURE-4问卷表现的参考。
结果:共纳入268例患者(115[42.9%]女性;平均年龄,47.1±12.6)。根据风湿病学家的诊断,PsA的患病率为12.7%(34例)。诊断为PsA的银屑病患者的平均PURE-4评分为2.3±1.1,无PsA的患者为1.3±1.3(P<0.001)。截止值≥2显示检测PsA的最佳性能,阴性预测值为95.1%(95%置信区间,90.3-97.6)。
结论:PURE-4问卷在检测PsA方面表现良好,最佳截止点≥2。这个简单的工具可以促进患者早期转诊到风湿病科。
OBJECTIVE: Psoriasis often precedes the onset of psoriatic arthritis (PsA), so dermatologists often face the challenge of early identifying signs of PsA in patients with psoriasis. Our aim was to validate the Spanish version of the PURE-4 questionnaire as a screening tool for PsA, evaluate its performance in terms of sensitivity, specificity, feasibility, reliability, and build validity.
METHODS: This was a cross-sectional, observational, multicenter trial of adult patients with psoriasis. Initially, patients were assessed by a dermatologist and completed 2 self-administered versions (in print and online) of the PURE-4 questionnaire. Afterwards, the rheumatologist, blinded to the PURE-4 results, assessed the presence/absence of PsA, being the reference to determine the performance of the PURE-4 questionnaire.
RESULTS: A total of 268 patients were included (115 [42.9%] women; mean age, 47.1±12.6). The prevalence of PsA according to rheumatologist diagnosis was 12.7% (34 patients). The mean PURE-4 score for patients with psoriasis diagnosed with PsA was 2.3±1.1, and 1.3±1.3 for patients without PsA (P<.001). The cutoff value ≥2 demonstrated the best performance for detecting PsA, with a negative predictive value of 95.1% (95% confidence interval, 90.3-97.6).
CONCLUSIONS: The PURE-4 questionnaire demonstrated good performance in detecting PsA, with an optimal cutoff point ≥2. This simple tool could facilitate early referral of patients to the rheumatology unit.