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Belinchón-Romero I, López-Ferrer A, Ferrán I Farrés M, Rivera-Díaz R, Vidal-Sarro D, Rodríguez Fernández-Freire L, de la Cueva-Dobao P, Santos-Juanes J, Rocamora-Durán V, Martín-Vázquez V, Gómez-Labradror L, Queiro-Silva R. Validation of the Spanish Version of the PURE-4 Questionnaire for the Early Detection of Psoriatic Arthritis in Psoriatic Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024; 115:654-662. [PMID: 38382746 DOI: 10.1016/j.ad.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Psoriasis often precedes the onset of psoriatic arthritis (PsA), so dermatologists often face the challenge of early identifying signs of PsA in patients with psoriasis. Our aim was to validate the Spanish version of the PURE-4 questionnaire as a screening tool for PsA, evaluate its performance in terms of sensitivity, specificity, feasibility, reliability, and build validity. METHODS This was a cross-sectional, observational, multicenter trial of adult patients with psoriasis. Initially, patients were assessed by a dermatologist and completed 2 self-administered versions (in print and online) of the PURE-4 questionnaire. Afterwards, the rheumatologist, blinded to the PURE-4 results, assessed the presence/absence of PsA, being the reference to determine the performance of the PURE-4 questionnaire. RESULTS A total of 268 patients were included (115 [42.9%] women; mean age, 47.1±12.6). The prevalence of PsA according to rheumatologist diagnosis was 12.7% (34 patients). The mean PURE-4 score for patients with psoriasis diagnosed with PsA was 2.3±1.1, and 1.3±1.3 for patients without PsA (P<.001). The cutoff value ≥2 demonstrated the best performance for detecting PsA, with a negative predictive value of 95.1% (95% confidence interval, 90.3-97.6). CONCLUSIONS The PURE-4 questionnaire demonstrated good performance in detecting PsA, with an optimal cutoff point ≥2. This simple tool could facilitate early referral of patients to the rheumatology unit.
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Affiliation(s)
- I Belinchón-Romero
- Departamento de Dermatología, Hospital General Universitario Dr. Balmis de Alicante-ISABIAL, Universidad Miguel Hernández, Alicante, España.
| | - A López-Ferrer
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | | | - R Rivera-Díaz
- Departamento de Dermatología, Hospital 12 de Octubre, Universidad Complutense, Madrid, España
| | - D Vidal-Sarro
- Departamento de Dermatología, Hospital de Sant Joan Despí Moisés Broggi, Barcelona, España
| | | | - P de la Cueva-Dobao
- Departamento de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España
| | - J Santos-Juanes
- Departamento de Dermatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - V Rocamora-Durán
- Departamento de Dermatología, Hospital de Manacor, Palma de Mallorca, Islas Baleares, España
| | | | | | - R Queiro-Silva
- División de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
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Belinchón-Romero I, López-Ferrer A, Ferrán I Farrés M, Rivera-Díaz R, Vidal-Sarro D, Rodríguez Fernández-Freire L, de la Cueva-Dobao P, Santos-Juanes J, Rocamora-Durán V, Martín-Vázquez V, Gómez-Labradror L, Queiro-Silva R. [Translated article] Validation of the Spanish Version of the PURE-4 Questionnaire for the Early Detection of Psoriatic Arthritis in Psoriatic Patients. ACTAS DERMO-SIFILIOGRAFICAS 2024:S0001-7310(24)00431-9. [PMID: 38815678 DOI: 10.1016/j.ad.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/19/2023] [Accepted: 02/12/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Psoriasis often precedes the onset of psoriatic arthritis (PsA), so dermatologists often face the challenge of early identifying signs of PsA in patients with psoriasis. Our aim was to validate the Spanish version of the PURE-4 questionnaire as a screening tool for PsA, evaluate its performance in terms of sensitivity, specificity, feasibility, reliability, and build validity. METHODS This was a cross-sectional, observational, multicenter trial of adult patients with psoriasis. Initially, patients were assessed by a dermatologist and completed 2 self-administered versions (in print and online) of the PURE-4 questionnaire. Afterwards, the rheumatologist, blinded to the PURE-4 results, assessed the presence/absence of PsA, being the reference to determine the performance of the PURE-4 questionnaire. RESULTS A total of 268 patients were included (115 [42.9%] women; mean age, 47.1±12.6). The prevalence of PsA according to rheumatologist diagnosis was 12.7% (34 patients). The mean PURE-4 score for patients with psoriasis diagnosed with PsA was 2.3±1.1, and 1.3±1.3 for patients without PsA (P<.001). The cutoff value ≥2 demonstrated the best performance for detecting PsA, with a negative predictive value of 95.1% (95% confidence interval, 90.3-97.6). CONCLUSIONS The PURE-4 questionnaire demonstrated good performance in detecting PsA, with an optimal cutoff point ≥2. This simple tool could facilitate early referral of patients to the rheumatology unit.
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Affiliation(s)
- I Belinchón-Romero
- Departamento de Dermatología, Hospital General Universitario Dr. Balmis de Alicante-ISABIAL, Universidad Miguel Hernández, Alicante, Spain.
| | - A López-Ferrer
- Departamento de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - R Rivera-Díaz
- Departamento de Dermatología, Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - D Vidal-Sarro
- Departamento de Dermatología, Hospital de Sant Joan Despí Moisés Broggi, Barcelona, Spain
| | | | - P de la Cueva-Dobao
- Departamento de Dermatología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - J Santos-Juanes
- Departamento de Dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - V Rocamora-Durán
- Departamento de Dermatología, Hospital de Manacor, Palma de Mallorca, Islas Baleares, Spain
| | | | | | - R Queiro-Silva
- División de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
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Elgaard C, Laurberg TB, Østgård RD, Pilegaard M, Steffensen P, Flanagan M, Fage-Butler A, Loft AG, Hjuler KF. Danish translation and cultural adaptation of the Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) scale. Scand J Rheumatol 2024; 53:140-145. [PMID: 38189320 DOI: 10.1080/03009742.2023.2295723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/13/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES Screening tools are needed to help to identify psoriatic arthritis in patients with psoriasis. The Psoriatic arthritis UnclutteRed screening Evaluation (PURE-4) questionnaire was developed for this purpose and has been shown to perform very well. The aim of this study was to translate and culturally adapt the PURE-4 scale into the Danish language. METHOD The translational process followed the guidelines provided by the Mapi Research Trust, which include the following steps: forward translation, backward translation, cognitive interviews, and proofreading. Following the guidelines helps to maintain the content validity of the questionnaire and secures a translation that is both literally and culturally appropriate for the target population. RESULTS All four items were modified throughout the translation process, involving mainly minor changes such as the addition of more colloquial words in the Danish version. The new Danish version of PURE-4 was reviewed and approved by the original developers. CONCLUSIONS A Danish version of the PURE-4 questionnaire was produced. The translation and cultural adaptation of PURE-4 constitute the first step in the validation of the questionnaire in Danish patients with psoriasis.
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Affiliation(s)
- Cdb Elgaard
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- National Centre of Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - T B Laurberg
- National Centre of Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - R D Østgård
- Department of Rheumatology, Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | | | - M Flanagan
- Department of English, Germanic and Romance Studies, University of Copenhagen, Copenhagen, Denmark
| | - A Fage-Butler
- Department of English, Aarhus University, Aarhus, Denmark
| | - A G Loft
- National Centre of Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - K F Hjuler
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
- National Centre of Autoimmune Diseases, Aarhus University Hospital, Aarhus, Denmark
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
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Urruticoechea-Arana A, Benavent D, León F, Almodovar R, Belinchón I, de la Cueva P, Fernández-Carballido C, Loza E, Gratacós J. Psoriatic arthritis screening: A systematic literature review and experts' recommendations. PLoS One 2021; 16:e0248571. [PMID: 33720981 PMCID: PMC7959352 DOI: 10.1371/journal.pone.0248571] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/01/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze the performance of psoriatic arthritis (PsA) screening tools, examine their implementation in daily practice, and reach a consensus about the best screening tool for implementation in daily practice in different medical settings. METHODS A systematic literature review (SLR), structured telephone interviews to hospitals, and a multidisciplinary nominal group meeting were all conducted. The SLR employed sensitive search strategies using Medline, Embase, and the Cochrane Library up to January 2020. Two reviewers independently selected articles that reported data on PsA screening tools and that included sufficient data to at least calculate the sensitivity and specificity of those tools (e.g., questionnaires, algorithms, specific questions, and biomarkers). The hospital interviews collected data regarding the process of suspected PsA diagnosis and referral to rheumatology, the implementation of PsA screening tools, and barriers and facilitators to implementation of those tools. In the nominal group meeting, a multidisciplinary team of experts discussed all these data and subsequently recommended a screening tool for implementation. RESULTS The SLR included 41 moderate-quality studies that analyzed 14 PsA screening tools, most of which were questionnaire-based tools. All of these studies reported a moderate-good performance but presented different characteristics regarding the time to completion or the number and type of items or questions. The implementation of screening tools was low (30.5%). The experts ultimately recommended regular use of a PsA screening tool, preferably the PURE-4 questionnaire. CONCLUSIONS The implementation of PsA screening tools like the PURE-4 questionnaire in daily practice likely improves the prognosis of PsA patients.
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Affiliation(s)
| | - Diego Benavent
- Rheumatology Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Fernando León
- Primary Care, San Juan de la Cruz Health Center, Pozuelo de Alarcón, Madrid, Spain
| | - Raquel Almodovar
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Isabel Belinchón
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, Spain
| | - Pablo de la Cueva
- Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Estíbaliz Loza
- Instituto de Salud Musculoesquelética, InMusc, Madrid, Spain
| | - Jordi Gratacós
- Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Spain
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Dermatologists’ Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. ACTAS DERMO-SIFILIOGRAFICAS 2020. [DOI: 10.1016/j.adengl.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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Belinchón I, Salgado-Boquete L, López-Ferrer A, Ferran M, Coto-Segura P, Rivera R, Vidal D, Rodríguez L, de la Cueva P, Queiro R. Dermatologists' Role in the Early Diagnosis of Psoriatic Arthritis: Expert Recommendations. ACTAS DERMO-SIFILIOGRAFICAS 2020; 111:835-846. [PMID: 32659259 PMCID: PMC7351070 DOI: 10.1016/j.ad.2020.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 12/31/2022] Open
Abstract
Psoriatic arthritis is a common type of inflammatory arthritis found in up to 40% of patients with psoriasis. Because skin involvement usually precedes joint involvement, dermatologists play a key role in early detection. Early diagnosis is important for reducing the risk of irreversible structural damage, attenuating the deterioration of physical function, and improving patients' quality of life. This consensus statement was drafted by a group of 9 dermatologists and 1 rheumatologist to provide simple recommendations to help dermatologists screen for psoriatic arthritis in patients with psoriasis. The experts offer consensus-based guidelines that draw on a review of available scientific evidence and on experience acquired in routine clinical practice.
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Affiliation(s)
- I Belinchón
- Servicio de Dermatología, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, España
| | - L Salgado-Boquete
- Servicio de Dermatología, Complejo Hospitalario Universitario de Pontevedra, Pontevedra, España
| | - A López-Ferrer
- Servicio de Dermatología, Hospital de la Santa Creu i Sant Pau, Barcelona, España
| | - M Ferran
- Servicio de Dermatología, Hospital del Mar, Barcelona, España
| | - P Coto-Segura
- Servicio de Dermatología, Hospital Álvarez-Buylla, Mieres, Asturias, España
| | - R Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, España
| | - D Vidal
- Servicio de Dermatología, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - L Rodríguez
- Servicio de Dermatología, Hospital Universitario Virgen del Rocío, Sevilla, España
| | - P de la Cueva
- Servicio de Dermatología, Hospital Universitario Infanta Leonor, Madrid, España.
| | - R Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
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