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银屑病关节炎CASPAR新诊断标准

邹先彪 主任医师 解放军总医院第四医学中心 皮肤科
2009-05-24 3481人已读
邹先彪 主任医师
解放军总医院第四医学中心
   众所周知,过去我们诊断银屑病关节炎主要用二十世纪70年代英国颁布的Moll & Wright诊断分类标准,因该标准未在不同人群中测试,敏感性和特异性较低。目前国际上普遍采用CASPARClassification Criteria for the Study of Psoriatic Arthritis study)诊断分类标准,该标准是由31个专家联盟制订的,并在588银屑病关节炎患者和536例其他炎性关节炎患者中进行了验证,其诊断敏感性和特异性分别达91.4%98.7%,特在此推出:

解放军总医院第四医学中心皮肤科邹先彪

已确定的炎性骨骼肌肉疾病(关节、脊柱或肌腱端)伴有如下至少3项:

1. 银屑病:(a)由合格健康专业人员确定目前存在银屑病皮疹或头皮疾病和/ (b)从患者或合格健康专业人员获得的银屑病病史和/(c)患者提供的其第1级或第2级亲属有银屑病史。

2.指甲改变:目前查体发现有典型银屑病指甲营养不良,包括指甲剥离、凹陷和过度角化。

3.RF阴性。

4.指(趾)炎:(a)目前整个指(趾)肿胀和/ (b)由合格健康医学人员记录的指(趾)炎史

5.放射线有关节邻近新骨形成证据: 手或足X线片上显示关节间隙附近有模糊骨化(但排除骨赘形成)

 

附原文:CASPAR Diagnostic Criteria of PsA

Established inflammatory musculoskeletal disease(joint, spine or entheseal) with three or more of the following:

1. Psoriasis: (a) current psoriatic skin or scalp disease currently present, as judged by a qualified health professional and/or (b) a history of psoriasis that may be obtained from patient, or qualified health professional and/or (c) a history of psoriasis in a first or second degree relative according to patient report.

2. Nail changes: typical psoriatic nail dystrophy, including onycholysis, pitting, and hyperkeratosis observed on current physical examination.

3. Negative test for RF.

4. Dactylitis (a) current swelling of an entire digit and/or (b) a history of dactylitis recorded by a qualified health professional.

5. Radiological evidence of juxta-articular new bone formation: Ill-defined ossification near joint margin (but excluding osteophyte formation) on plain radiographs of hand or foot.

Criteria yield specificity 98.7%,  sensitivity 91.4%

 

引自:Taylor W, Gladman D, Helliwell P, et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum. 2006,54:2665-73.

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邹先彪 主任医师

解放军总医院第四医学中心 皮肤科

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