PASE and EARP questionnaires for the identification of enthesitis, synovitis, and tenosynovitis in patients with psoriasis

Abstract

The aim of this study was to assess the diagnostic value of the Psoriatic Arthritis Screening Evaluation (PASE) and Early Psoriatic Arthritis Screening Questionnaire (EARP) questionnaires in the ultrasonographic detection of enthesitis, synovitis, and tenosynovitis. A cross-sectional study was done in a total of 96 consecutive patients. Double blind clinical examination and echographic assessment were performed. A receiver-operating characteristic (ROC) model analysis for the questionnaires was established using echographic findings as reference variable. The optimal diagnostic point was determined following a Youden analysis model from the obtained data, calculating sensitivity and specificity along with predictive values, likelihood ratio, and diagnostic odds ratio. A logistic regression analysis was used to determine possible predictor variables of enthesitis, synovitis, and tenosynovitis. When enthesitis, synovitis, and tenosynovitis were considered as one outcome for the diagnostic study of the PASE or EARP questionnaire, there were no statistically significant differences among the score of the study groups and the rest of patients. The PASE and EARP tests had a diagnostic performance for enthesitis, synovitis, and tenosynovitis that followed the expected pattern when the prevalence of findings is low. In these cases, the tests increase their negative predictive value, being particularly interesting in ruling out the disease.

Psoriatic arthritis screening: A systematic literature review and experts’ recommendations

“…The following questionnaire-based tools were included in the present SLR: PEST [10, 14, 49, 54-57, 67, 69, 73-75, 81], PASE [10,13,16,49,51,52,55,56,59,60,63,66,67,70,75,[79][80][81], EARP [16,49,54,67,71,75,80], ToPAS [10,15,49,53,55,56,62,74,75,79], ToPAS 2 [61,78], SiPAT (45) [54], PURE-4 [17], CONTEST [49,[56][57][58], GEPARD [65,72], PASQ [50,74], ePASQ [68], and SiPAS [77]. The number of items included in these questionnaires varied from 4…”

“…The gold standard for PsA diagnosis also varied. The CASPAR criteria were widely used [10, 15-17, 47-50, 52, 54, 55, 58, 59, 61-63, 65, 67-73, 75, 77-79], but the Moll and Wright criteria [13,51,60], rheumatologist's criteria [14,50,53,56,57,64,74], and others were all also employed [80].…”

“…The AUC of screening tools was higher than 80% in the majority of studies. This was not the case for the following individual studies, which are grouped by PsA screening tool: PASE [55,58,67,80], PEST [55,58,59,67], CONTEST [59], ToPAS [55,58], PASQ [14], and EARP [67,80].…”

“…• PEST: Se = 56%; Sp = 85%; PV+ = 50; PV-= 88 • PEST (cut-off �2): Se = 89%; Sp = 63%; PV+ = 39; PV-= 96López-Estebaranz_2015[70] • PASE (cut-off �44): Se = 51%; Sp = 78%(73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83); AUC = 0.707Maejima_2016[71] • J-EARP: AUC = 0.99; Se = 97.2%; Sp = 97.2%Martire_2019[72] •GEPARDa (cut-off �6): Se = 88.6%; Sp = 89.7%; LR+ = 8.6; LR-= 0.12; AUC = 0.955 (0.91-0.99) Mazzotti_2019 [73] • PEST-bp: Se = 84.6%; Sp = 63.3%; PV+ = 37.9; PV-= 93.9; AUC = 0.81 (0.73-0.88) Mease_2014 [74] • PASQ: Se = 67%; Sp = 64%; PV+ = 43; PV-= 83 • PEST: Se = 84%; Sp = 75%; PV+ = 60; PV-= 91 • ToPAS: Se = 77%; Sp = 72%; PV+ = 54; PV-= 88 Mishra_2017 [75] • EARP: Se = 91%; Sp = 88%; AUC = 0.95 • PASE (cut-of �44): Se = 80%; Sp = 95%; AUC = 0.93 • PEST: Se = 53%; Sp = 95%; AUC = 0.92 • ToPAS: Se = 44%; Sp = 97%; AUC = 0.93 Oyur_2014 [51] • PASE (cut-off �44): Se = 62%; Sp = 76% Piaserico_2016 [76] • iPASE (cut-off �48): Se = 73.2%; Sp = 76.1%; AUC = 0.821 35 Salaffi_2018 [77] • SiPAS: Se = 79%; Sp = 87%; LR+ = 6.Tinazzi_2012 [16] • PCA: exclusion of 4 items (EARP of 10 items) α Cronbach = 0.83 • AUC PASE (cut-off �44) vs EARP: 0.895 vs 0.906 • EARP: Se = 85.2%; Sp = 91.6% • PASE (cut-off �44): Se = 90.7%; Sp = 67.2% 37 Tom_2015 [78] • ToPAS 2_cap (cut-off �8): Se = 87.2%; Sp = 82.7%; AUC = 0.910 38 Urbancek_2016 [79] • ToPAS vs PASE • Se: 72.6% vs 58.9% • Sp: 81.3% vs 80.5% 39 Vidal_2016 [80] • Tenosynovitis • PASE: Se = 66.7%; Sp = 63.4%; PV-= 93.3%; AUC = 0.65 • EARP: Se = 100%; Sp = 48.8%; PV-= 100%; LR+ = 1.81; AUC = 0.74 • Synovitis • PASE: PV+ = 12.3%; PV-= 93.5%; AUC = close to 0.50 • EARP: Se = 66.7%; Sp = 60.8%; PV-= 94.1%; LR+ = 1.65; AUC = 0.66 • Enthesitis • PASE: Se = 100%; Sp = 19.5%; PV+ = 8.3%; PV-= 100%; AUC = 0.66 • EARP: PV+ = 8.3%; PV-= 100%; AUC = 0.60 • PsA • PASE: Se = 100%; Sp = 66%; PV+ = 9%; PV-= 100%; AUC = 0.83 • EARP: not relevant for the PsA diagnosis 40 Walsh_2013 [81] • PEST: Se = 85%; Sp = 45% • ToPAS: Se = 75%; Sp = 55% • PASE: Se = 68%; Sp = 50% • PASE (�44): Se = 78%; Sp = 40% 41 You_2015 [52] • Korean PASE (cut-off �37): Se = 77.8%; Sp = 82.3%; PV+ = 37.8; PV-= 96.4; AUC = 0.82 (0.72-0.92) Abbreviations: CI = confidence interval; Se = sensitivity; Sp = specificity; PPV = Positive Predictive Value; NPV = Negative Predictive Value; AUC = area under the curve; FA: factor analysis; KR = Kunder-Richardson; ePASQ = electronic Psoriasis and Arthritis Screening Questionnaire; SiPAS = Simple Psoriatic Arthritis Screening; CEPPA = Center of Excellence for Psoriasis and Psoriatic Arthritis; GEPARD = GErman Psoriasis ARthritis Diagnostic questionnaire https://doi.org/10.1371/journal.pone.0248571.t002…”

Spanish Validation of the GEPARD Questionnaire for the Detection of Psoriatic Arthritis in Argentinian Patients with Psoriasis

“…Over the last few years, new tools have been developed to improve the detection of PsA in patients with psoriasis [9-13]. In 2010, Härle et al [14] presented a self-administered questionnaire containing 14 questions that were selected by consensus.…”