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SASPA patient-administered tool reliably monitors PsA activity
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The patient-administered Stockerau Activity Score for Psoriatic Arthritis questionnaire was reliable, valid and sensitive to change, according to study findings.
Researchers administered a modified version of the German-language Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5) to patients with psoriatic arthritis (PsA) designed to measure disease activity without taking joint counts. The questionnaire comprised five items from the RADAI-5 and one item specific to psoriatic arthritis rated on a Likert scale from 0 to 10.
The five questions from the RADAI-5 included on the Stockerau Activity Score for Psoriatic Arthritis (SASPA) questionnaire were, “How active was your arthritis in the last 6 months?” “How active is your arthritis today with respect to joint tenderness and swelling?” “How severe is your arthritis pain today?” “How would you describe your general health today?” and “Did you experience joint (hand) stiffness on awaking yesterday morning? If yes, how long was this stiffness?” For patients with PsA, the question, “How active do you regard your skin disease?” was added.
Patients self-reported on the questionnaire and were examined using a tender joint count (TJC), swollen joint count (SJC), assessment of the presence of dactylitis and enthesiopathy, physician’s assessment of disease activity on a VAS, laboratory tests to evaluate erythrocyte sedimentation rate (ESR) and patient satisfaction with disease status.
Cronbach’s alpha was used as a measure of internal consistency to explore the validity of the questionnaire compared to clinical measures of disease activity. A mono-component structure (Eigenvalue 3.628) was seen after factorial analysis and items loading between questions six (0.558) and three (0.892), which demonstrated the aggregate results were based on the sum contributions of each item, according to the researchers. Further analysis showed the questionnaire was as or more reliable without question one, which was discarded in the final model, yielding a five-item questionnaire.
The final questionnaire was administered at several intervals to 152 patients with PsA, with 779 questionnaires completed, and clinical assessments identical to the first trial were made. Consensus meetings were held between the treating physicians to ensure consistency in joint evaluation.
Statistical analysis to compare the scores on the questionnaire with clinical assessment data showed that the Cronbach’s alpha score of 0.875 surpassed the limit for internal consistency. Analysis showed that SASPA values were consistent with TJC, SJC and physician’s global assessment. No association was seen with SASPA and ESR, according to the researchers.
The researchers further analyzed the results in 19 patients who began tumor necrosis factor-alpha inhibitor treatment and followed up in 4.1 months with additional questionnaires. Mean SASPA scores before treatment were 4.51 and dropped to 1.87 after 4 months of treatment, reflecting a therapeutic intervention and SASPA sensitivity to change, the researchers reported. -by Shirley Pulawski
Disclosure: The researchers report no relevant financial disclosures.
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