银屑病关节炎CASPAR新诊断标准

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CASPAR（Classification 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例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%和98.7%，特在此推出：

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/或（b）从患者或合格健康专业人员获得的银屑病病史和/或（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/或（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.