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CASPAR study. Philip Helliwell Will Taylor On behalf of the CASPAR study group. Areas to be covered. What is the CASPAR study? What happened before CASPAR? What is the future beyond CASPAR? Will it change our daily practice?. Aim of CASPAR.
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CASPAR study Philip Helliwell Will Taylor On behalf of the CASPAR study group
Areas to be covered • What is the CASPAR study? • What happened before CASPAR? • What is the future beyond CASPAR? • Will it change our daily practice?
Aim of CASPAR • To compare the test performance characteristics of existing classification criteria • To determine whether new criteria derived from observed data would be more accurate than these existing criteria
What happened before CASPAR? Most authors used Moll and Wright • Inflammatory arthritis, psoriasis and the (usual) absence of rheumatoid factor
Vasey & EspinozaIn: Calin A, editor. Spondyloarthropathies. Orlando, Florida: Grune & Stratton; 1984. p. 151-185
Design • Prospective, observational study of consecutive clinic patients with PsA and other inflammatory arthritis (at least 50% rheumatoid arthritis) • Target sample size of 1012 in total • 30 clinics in 13 countries • Gold-standard of diagnosis based on physician’s opinion • Data collected between Feb 02 to Mar 04
CASPAR was a first! • CASPAR was the first World Wide collaboration of committed researchers in psoriatic arthritis • The forerunner of GRAPPA • Bigger (and better) than any of the other rheumatological criteria sets
The CASPAR criteria • Why didn’t spinal features appear in the criteria? • Why didn’t enthesitis appear in the criteria? • What is the definition of ‘inflammatory articular disease’? • Are these criteria suitable for classifying early disease? • Are these criteria suitable for diagnosis at the bedside?
The bedside exceptions • Combination of a dactylitic toe and Achilles tendon insertional enthesitis • A swollen knee and nail pitting • Seronegative polyarticular disease, a family history of psoriasis in a first degree relative and severe radiological osteolysis • Unilateral sacroiliitis and a history of psoriasis
What is planned for the future? • For now CASPAR criteria should be used for clinical trials: permits uniformity and moves towards homogeneity • Further development: • Planned studies: • Clinical and radiological examination of a population of subjects with psoriasis and articular symptoms (screening questionnaire) • Prospective study of a population of subjects with early disease • Closer look at CCP positive subjects
CASPAR – Development and validation of classification criteria for psoriatic arthritis • UK: Dr L Kay, Newcastle; Dr A Adebajo, Sheffield; Dr A Isdale, Northallerton; Prof P Emery, Leeds; Dr D McGonagle, Halifax; Dr N McHugh, Bath, P Helliwell, Bradford • Belgium: Prof Herman Mielants, Dr K DeVlam. • Italy: Dr A Marchesoni, Dr I Olivieri, Dr C Salvarani, Dr E Lubrano. • Spain; JC Torre-Alonso • France: Prof B Fournie, Prof M Dougados. • Sweden: Dr B Svensson, Dr S Dahlqvist, Dr Alenius • Canada: Prof D Gladman, Prof A Russell. • New Zealand:Dr W Taylor. • South Africa: Prof Girish Modi, Dr A Kalla. • Morocco: Prof Houssani. • Australia: Dr M Lassere. • Ireland: Dr D Veale, Dr O Fitzgerald. • United States: Dr Luis Espinoza, Dr P Mease, Dr C Ritchlin. • Main Centre: University of Leeds, UK
Acknowledgements • Funding:EULAR, Barnsley District NHS Trust, Groote Schuur Hospital (Cape Town), Department of Medical Sciences (University Hospital, Uppsala), Krembil Foundation, St. Vincent’s University Hospital Radiology Department (Dublin), Inkosi Albert Luthuli Central Hospital (Durban), El Ayachi Hospital (Morocco), National Psoriasis Foundation (USA), The Foundation for Scientific Research of the Belgian Society of Rhumatology, Arthritis New Zealand. • Radiology: Guy Porter, Keighley, UK • CCP analysis: Neil McHugh, Pat Owen, Bath, UK • Statistical analysis: Will Taylor, John Horwood, NZ