Artikel
Predictive value of different questionnaires for diagnosing Psoriatic Arthritis in patients with Psoriasis in daily routine care
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Autoren
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Michaela Köhm
- Abteilung Rheumatologie, Universitätsklinikum Frankfurt & Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
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Stephanie Dauth
- Fraunhofer IME Projektgruppe TMP, Frankfurt
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Tanja Rossmanith
- Klinische Forschung, Fraunhofer IME, Projektgruppe Translationale Medizin und Pharmakologie (TMP), Frankfurt am Main, Frankfurt am Main
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Hans-Eckhard Langer
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf, Düsseldorf
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Gerd-Rüdiger Burmester
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Berlin
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Ulrich Käßer
- Schwerpunktpraxis für Rheumatologie am Krankenhaus Balserische Stiftung, Rheumatologie, Gießen
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Marina Backhaus
- Park-Klinik Weissensee, Abteilung für Innere Medizin - Rheumatologie und Klinische Immunologie, Berlin
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Siegfried Wassenberg
- Rheumazentrum Ratingen, Ratingen
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Benjamin Köhler
- Evangelisches Fachkrankenhaus, Rheumatologische Klinik, Ratingen
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Harald Louis Burkhardt
- Klinikum der Johann Wolfgang Goethe-Universität, Medizinische Klinik II, Rheumatologie, Fraunhofer Institute for Molecular Biology and Applied Ecology IME, Project Group Translational Medicine & Pharmacology TMP, Frankfurt/Main
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Frank Behrens
- Johann Wolfgang Goethe University & Fraunhofer IME-TMP, Frankfurt, Germany, Frankfurt, Germany
| Veröffentlicht: | 4. September 2017 |
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Gliederung
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Background: Psoriasis (PsO) is one of the most common chronic inflammatory skin disease in Europe, with at least 100 million individuals affected worldwide. Approximately 34.7% of the individuals with psoriasis develop psoriatic arthritis (PsA) which leads to joint deformations and disability. Skin manifestations appear usually years before PsA-related symptoms emerge, but due to its distinct clinical presentation, detection of PsA is still difficult. For the detection of PsA in clinical routine care questionnaires such as PASE, PEST, and GEPARD are validated tools with different sensitivity and specificity levels especially used in Dermatology department.
Methods: 150 patients with a dermatologically confirmed PsO diagnosis and without a pre-existing PsA diagnosis were included for a prospective, multicenter study in Germany (XCITING). Patients presented with risk factors for PsA development (e.g., nail psoriasis and/or joint pain or swelling within the last 6 months). Clinical examination and standardized ultrasound was performed by a qualified rheumatologist to assess PsA diagnosis. Additionally, patients were asked to complete PASE, PEST, and GEPARD questionnaires of which results were analyzed regarding the suspicion of PsA. Their results were compared to diagnosis levels of clinical routine care in order to survey their sensitivity, specificity and their positive and negative predictive values for the detection of PsA.
Results: 46.4% of the PsO patients were diagnosed with PsA by a rheumatologist using clinical examination and ultrasound. For the detection of PsA, the sensitivity of the PASE questionnaire was 44.3% and its specificity was 64.2%. The PASE questionnaire further had a positive predictive value of 51.7% and a negative predictive value of 57.1%. For the PEST questionnaire, the sensitivity was calculated with a value of 12.9% and the specificity with a value of 80.3%. The positive predictive value of PEST was 36%, its negative predictive value 51.6%. For the detection of PsA the GEPARD questionnaire showed a sensitivity of 64.3% and a specificity of 38.3%. It has a calculated positive predicted value of 47.4% and a negative predictive value of 55.4%.
Conclusion: The highest positive and negative predictive values for the detection of PsA were observed for the PASE questionnaire in comparison with the PEST and GEPARD questionnaire. For use in clinical routine care only the combination of both, questionnaires together with clinical examination should be performed for proper PsA diagnosis, illustrating the high need of cooperation setting between dermatologists and rheumatologists.
