 |
|
|
 |
The Clinical Assessment of Patients with Psoriatic Arthritis: Results of a Reliability Study of the Spondyloarthritis Research Consortium of Canada
DAFNA D. GLADMAN, RICHARD J. COOK, CATHY SCHENTAG, MARIE FELETAR, ROBERT I. INMAN, CAROL HITCHON, JACOB KARSH, ALICE V. KLINKHOFF, WALTER P. MAKSYMOWYCH, DIANNE P. MOSHER, BINDU NAIR, and MILLICENT A. STONE
ABSTRACT.
Methods. Ten patients with PsA, representing a broad range of joint inflammation, joint damage, and spinal involvement, were selected for the study. Each patient was examined by each of 10 rheumatologists, members of the Spondyloarthritis Research Consortium of Canada, according to a Latin Square design. Assessments included scoring actively inflamed joints and damaged joints, dactylitis, enthesitis, and spinal measurements. Variance components analyses were conducted for continuous measurements based on models with observer, patient, and order effects. Estimates of intraclass correlation coefficients and associated 95% confidence intervals were obtained. Results. There was substantial reliability in the assessment of the number of actively inflamed joints and excellent agreement in the number of damaged joints. Only moderate agreement was found for the number of digits with dactylitis. There was excellent agreement among observers in the intermalleolar distance measurements, but there was not as good agreement in the other measurements of spinal mobility. There was good agreement among the observers in detecting plantar fasciitis, however, the other entheses did not fare as well. Conclusion. In this first multicenter study of the assessment of clinical evaluation of patients with PsA we found that the assessment of peripheral joint disease is reliable although training should be performed prior to initiation of drug trials or comparative studies in this disease. The assessment of back measurements in PsA and other spondyloarthritis requires further study. (J Rheumatol 2004;31:1126-31) Key Indexing Terms:
PSORIATIC ARTHRITIS
From The Psoriatic Arthritis Program, University of Toronto, Toronto; University of Waterloo, Waterloo; University of Ottawa, Ottawa, Ontario; University of Manitoba, Winnipeg, Manitoba; University of Alberta, Edmonton, Alberta; Dalhousie University, Halifax, Nova Scotia; University of Saskatchewan, Saskatoon, Saskatchewan. D.D. Gladman, MD, FRCPC, Professor of Medicine, University of Toronto, Director, Psoriatic Arthritis Program; R.J. Cook, PhD, Professor, Department of Statistics and Actuarial Science, University of Waterloo; C. Schentag, MSc, Research Associate; M. Feletar, MBBS(Hons), FRACP, Clinical Research Fellow, Psoriatic Arthritis Program, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital; R.I. Inman, MD, FRCPC, Professor of Medicine, University of Toronto; C. Hitchon, MD, FRCPC, Assistant Professor of Medicine, University of Manitoba; J. Karsh, MDCM, FRCPC, Professor of Medicine, University of Ottawa; A. Klinkhoff, MD, FRCPC, Assistant Professor of Medicine, University of British Columbia; W. Maksymowych, MD, FRCPC, Associate Professor of Medicine, University of Alberta; D. Mosher, MD, FRCPC, Associate Professor of Medicine, Dalhousie University; B. Nair, MD, FRCPC, Assistant Professor of Medicine, University of Saskatchewan. M.A. Stone, MB, MRCP(UK), Assistant Professor of Medicine, University of Toronto. Address reprint requests to Dr. D. Gladman, Toronto Western Hospital, ECW 5-034B, 399 Bathurst St., Toronto, Ontario, M5T 2S8. E-mail: dafna.gladman@utoronto.ca Submitted April 11, 2003; revision accepted December 30, 2003.
|