Modification of Cardiovascular Risk Tool Does Not Improve Predictive Ability in PsA

A cardiovascular risk assessment tool modified according to EULAR recommendations did not improve predictive performance in patients with PsA.

Modification of the cardiovascular (CV) risk tool ASSIGN based on European League Against Rheumatism (EULAR) recommendations did not improve calibration and predictive performance in patients with psoriatic arthritis (PsA), according to results from a study published in Clinical Rheumatology.

Researchers conducted a retrospective study of 155 patients with PsA using records from 2 separate Italian cohorts. The team applied the EULAR recommendation to modify the risk algorithm using a multiplication factor of 1.5 and subsequent changes in calibration and discriminatory ability were examined. Following these adaptations, advanced statistical techniques were used to assess the performance of the modified CV risk tool in study patients.

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After statistical analysis, the researchers found that calibration and predictive capacity of the modified tool were not enhanced after applying the EULAR recommendations. The area under the receiver operating characteristic curve was 0.81790 (95% CI, 0.72014-0.91558) for the original risk tool, 0.8160 (95% CI 0.71661-0.91529) for an algorithm modified for patients with rheumatoid arthritis, and 0.8179 (95% CI, 0.72014-0.91558) for the algorithm adapted according to EULAR recommendations for patients with PsA. The researchers noted that without modification, the ASSIGN tool may still be useful as a risk tool to evaluate patients with PsA.

The authors acknowledged that a key limitation of the study was the small sample size, which could have reduced the statistical power of some measures.

“A good discriminative ability of the ASSIGN algorithm has been reported, without any improvement using the multiplication factor suggested by EULAR recommendations,” the researchers wrote.

“Further studies are needed in order to improve CV risk prediction in [patients with PsA] and to assess preventive strategies towards a CV-personalized medicine in patients with inflammatory arthritis,” they concluded.


Navarini L, Margiotta DPE, Costa L, et al. Performance and calibration of the algorithm ASSIGN in predicting cardiovascular disease in Italian patients with psoriatic arthritis [published online January 24, 2019]. Clin Rheumatol. doi: 10.1007/s10067-019-04442-3