Journal Article

AB0471 DIAGNOSTIC PERFORMANCE OF THE CASPAR CRITERIA IN THE SPANISH VALIDATION STUDY OF THE PURE-4 QUESTIONNAIRE

Joven-Ibáñez, B., Beltrán, E., Jovani, V., Laiz, A., Soler Salas, A., Belinchón, I., Crespi-Martinez, L., García Vivar, M. L., Queiro, R., Erra, A., Reina, D., Michelena, X., Galíndez-Agirregoikoa, E., Guinea Uzábal, G., Gómez Labrador, L.

2024

Overview

Background:The CASPAR classification criteria present a high sensitivity/specificity for the classification of psoriatic arthritis (PsA) patients (pts). Although initially designed for classification purposes, many authors have used them for diagnostic (dx) purposes with variable results. The Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire has recently been validated for its use in the Spanish dermatological healthcare context, showing good sensitivity/specificity for the PsA detection [1].Objectives:To analyze the performance of the CASPAR criteria in the pts included in this validation study and who received a PsA dx by the rheumatologist.Methods:Cross-sectional, observational, multicenter study conducted with primary data collection under conditions of routine clinical practice in Spain. Adult pts with psoriasis that voluntarily accepted to participate. Two cross-sectional assesments: Assessment I allowed to validate the Spanish version of the PURE-4 questionnaire and assessment II (pts without PsA in assessment I were evaluated for PsA confirmation by the rheumatologist 1 year ±2 months later). The ability of the Spanish version of the PURE-4 questionnaire to screen for PsA among pts with psoriasis receiving routine dermatology care in Spain was previously confirmed.1 Main findings were: (i) the questionnaire showed an acceptable overall discrimination capacity (AUC=73% in assessment I, AUC=76% in assessment II), acceptable reliability (Cronbach’s α=0.610), and good construct validity; (ii) optimal cut-point of ≥2 points allows screening pts with or without PsA with good sensitivity (79.4%) and specificity (80.7%); (iii) PURE-4 was sensitive (75%) predicting an early PsA dx at 1-year follow-up; (iv) the cut-point of ≥2 is optimal, both for detecting PsA in the short term (1 month) and in the long term (1 year). Among the external anchors used to analyze the construct validity of the PURE-4, the CASPAR criteria were included. The performance and agreement of the CASPAR criteria against physician´s dx (gold standard) was analyzed. Mann-Whitney and Chi square tests were used to evaluate the differences in the characteristics of pts with and without PsA according to the rheumatologist’s dx.Results:Of the 268 evaluable pts in assessment I, 34 presented PsA. In assessment II, 219 pts were evaluable and 12 of these pts developed PsA after one year (Figure 1). At the end of the study, 46 pts with PsA were observed (18.3%, 46/251 with complete follow-up). In assessment I, 21/34 pts with PsA (61.8%) met CASPAR criteria, 4 (19%) did not meet them, and in the remaining 9 they were not available (26.5%). In assessment I, 95.2% of those who met the CASPAR classification criteria fulfilled the item of current psoriasis, 62% nail dystrophy, 24% dactylitis, and 24% radiographic criteria. Mean (SD) PURE-4 score [2.19 (1.29)] was significantly higher in pts who met CASPAR criteria than in pts who did not meet these criteria [1.29 (1.26); p=0.002). 66.7% of the pts who presented PsA according to the CASPAR criteria obtained PURE-4 score ≥2. The percentage of agreement between both criteria (PURE-4 and CASPAR) was 61.4%. In assessment II, of the 12 pts with PsA dx, 7 met the CASPAR criteria (58.3%), 3 did not (25%), and it was not available in 2 pts. In this second evaluation, all pts met the item for current psoriasis, 28.6% for nail dystrophy, 28.6% for dactylitis, while none met the radiographic criteria.Conclusion:The CASPAR criteria had adequate dx performance in the Spanish validation study of PURE-4 questionnaire, however the criterion that should prevail in the dx of PsA continues to be that of a rheumatologist experienced in this pathology.REFERENCES:[1] Ruben Queiro, et al. Poster POS1075. Congreso EULAR 2022.Figure 1.Study population flow chartPsA, psoriatic arthritis.Acknowledgements:The authors thank IQVIA and Carmen Barrull and Marco Pinel for providing medical editorial assistance with this presentation.Disclosure of Interests:Rubén Queiro Abbvie, Amgen-Celgene, Eli-Lilly, Janssen, MSD, Novartis, Pfizer, UCB, Amgen-Celgene, Eli-Lilly, Janssen, Novartis, UCB, Abbvie, Janssen, Novartis, Isabel Belinchón Janssen Pharmaceuticals Inc, Almirall SA, Lilly, AbbVie, Novartis, Celgene, Biogen, Amgen, Leo-Pharma, Pfizer-Wyeth, BMS, UCB, y MSD, Janssen Pharmaceuticals Inc, Almirall SA, Lilly, AbbVie, Novartis, Celgene, Biogen, Amgen, Leo-Pharma, Pfizer-Wyeth, BMS, UCB, y MSD, Alba Erra: None declared, Xabier Michelena Novartis, Lilly, Abbvie, Janssen, UCB, Novartis, Abbvie, Janssen, UCB, Beatriz Joven-Ibáñez Abbvie, Novartis, Lilly, Abbvie, Janssen, UCB, Amgen, UCB, Janssen, Abbvie, BMS, Janssen, Laura Crespi-Martinez Abbvie, Galapagos, Emma Beltrán AbbVie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche y UCB, AbbVie, Bristol, Celgene, Janssen, Lilly, MSD, Novartis, Pfizer, Roche y UCB, Ana Laiz UCB, AMGEN, ABBVIE, MSD, JANSSEN, NOVARTIS, UCB, AMGEN, ABBVIE, MSD, JANSSEN, NOVARTIS., UCB, AMGEN, ABBVIE, MSD, JANSSEN, NOVARTIS., UCB, AMGEN, ABBVIE, MSD, JANSSEN, NOVARTIS., Vega Jovani: None declared, Delia Reina: None declared, Eva Galíndez-Agirregoikoa Abbvie, Novartis, Pfizer, Janssen, Amgen, UCB, Lilly, Abbvie, Novartis, Pfizer, Janssen, Amgen, UCB, Lilly, María L. García Vivar Abbvie, Bristol, Pfizer, Novartis, UCB. Janssen, Lilly, Sandoz, Abbvie, UCB, Novartis, Janssen, Guillermo Guinea Uzábal I am a Novartis employee, Lara Gómez Labrador I am a Novartis employee, Adriana Soler Salas I am a Novartis employee.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier B.V,Elsevier Limited
• Subject: Classification / Dactylitis / Diagnostic test / Dystrophy / Interdisciplinary research / Population studies / Psoriasis / Psoriatic arthritis / Questionnaires / Real-world evidence / Scientific Abstracts / Sensitivity analysis / Validation studies