Session Information
Date: Monday, November 9, 2015
Title: Spondylarthropathies and Psoriatic Arthritis - Comorbidities and Treatment Poster II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: To date, although several have been proposed, there are no validated remission criteria in psoriatic arthritis (PsA). Validated criteria for minimal disease activity (MDA) in PsA have been established. This study aimed to compare sensivity and specificity of different potential remission criteria to identify patients in remission as defined by musculoskeletal ultrasound (US).
Methods: In this cross sectional study PsA patients were consecutively recruited from an outpatient clinic. All the patients fulfilled the CASPAR criteria for PsA. The following potential remission criteria were assessed: (1) Disease Activity Index for Psoriatic Arthritis (DAPSA) ≤3.3, (2) Composite Psoriasis Disease Activity Index (CPDAI) <2, (3) Psoriatic ArthritiS Disease Activity Score (PASDAS) <2.4 (4) Boolean’s definition of remission modified for PsA, meeting all of the following criteria: 68 tender joints (TJC68) ≤1, 66 swollen joints (SJC66)≤1, Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) ≤1, dactylitis count ≤1, evaluator’s global assessment (EGA) ≤1 (0-10 scale), patient’s global assessment (PGA) ≤1 (0-10 scale), C-reactive protein ≤1mg/dl (5) MDA, meeting 5 of the 7 following criteria: TJC68 ≤1, SJC66 ≤1, Psoriasis Area Severity Index (PASI) ≤1, patient’s pain ≤15 (0-100 scale), PGA ≤20 (0-100 scale), Modified Health Assessment Questionnaire (MHAQ) ≤0.5 and MASES ≤1. US evaluation was performed on 68 joints, 15 tendons and 29 entheses if clinical findings indicating inflammation. Mandatory US evaluation was performed on 34 joints, 15 tendons and 10 entheses. US remission was defined as power Doppler (PD) score=0 in all joints, entheses and tendons. Chi-Square test or Fishers exact test (as appropriate) was used to calculate proportions. The odds ratio (OR) within the 95% confidence interval was calculated using the 2 x 2 table. A value of p<0,05 was accepted as statistically significant.
Results: A total of 141 PsA patients were included. Mean (SD) age was 52,4 (10,2) years, mean disease duration 9,5 (6,6) years and 72% were females. Median (range) TJC68 was 6 (0-55), SJC66 0 (0-6), MASES 2 (0-13). Mean (SD) EGA was 14,8 (12,3), PGA 36,3 (24,4), DAPSA 18,3 (14,1), CPDAI 6,2 (2,7) and PASDAS 3,1 (0,4). Overall, US remission was achieved by 70 (49,6%) patients. Sensivity and specificity of clinical criteria to identify patients in US remission are displayed in the table.
|
|
Sensivity (%) |
Specificity (%) |
OR (95% CI) |
p |
|
MDA (n=32) |
30.0 |
84.3 |
2.3 (1.0-5.2) |
0.048 |
|
DAPSA≤3.3 (n=14) |
15.7 |
95.8 |
4.2 (1.1-15.9) |
0.025 |
|
CPDAI>2 (n=12) |
13.0 |
95.7 |
3.4 (0.9-13.0) |
0.066 |
|
PASDAS<2.4 (n=11) |
8.6 |
93.0 |
1.2 (0.4-4.3) |
0.748 |
|
Boolean’s for PsA (n=8) |
10.0 |
98.6 |
7.8 (0.9-65.0) |
0.033 |
Conclusion: MDA, DAPSA and Boolean’s PsA remission criteria had some utility as regards identifying PsA patients in US remission. Off note, while the specificity of these criteria was good, the sensivity was quite poor.
To cite this abstract in AMA style:
Michelsen B, Diamantopoulos AP, Hammer HB, Kavanaugh A, Haugeberg G. Sensivity and Specificity of Clinical Criteria to Identify Patients in Ultrasound Remission in Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/sensivity-and-specificity-of-clinical-criteria-to-identify-patients-in-ultrasound-remission-in-psoriatic-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/sensivity-and-specificity-of-clinical-criteria-to-identify-patients-in-ultrasound-remission-in-psoriatic-arthritis/