Objective: to study the clinical characteristics of PsA and working capacity in patients included in the All-Russian PsA Registry.Patients and methods. The investigation enrolled 614 patients aged 19–84 years with psoriasis from 39 subjects the Russian Federation, who were followed up in the All-Russian PsA Registry. On the basis of the assessment of demographic data, the spectrum of comorbidities, the degree of activity of the underlying disease according to Disease Activity Index for PsA (DAPSA) and Disease Activity in 28 joints (DAS28), clinical, functional, and social indicators were analyzed in the patients. The investigators studied information on the patients employment, working capacity, and disability, by assessing the group of the latter. The health status and the presence and severity of functional impairment in the patients were analyzed using the Health Assessment Questionnaire (HAQ), while their working efficiency was estimated according to the Workers Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI-SHP questionnaire), by calculating the following parameters: absenteeism, presenteeism, an overall decrease in labor productivity, and impairment in daily functional activity.Results and discussion. The analysis of the All-Russian PsA Registry showed that most of them were of working age (30 to 59 years); 48.4% had concomitant diseases. Data on DAPSA changes were obtained in 349 patients, who were recorded to have mainly moderate (34.7%) or high (42.7%) disease activity, multiple dactylitides and enthesitides, and limited joint function. The registry reflects information on the social status of 521 patients: employed (61.2%) and unemployed (22.1%) persons, pensioners (15.2%), and students (1.5%). More than one third (37.1%) of patients with PsA had disability, mainly of Group III. The changes in the HAQ disability index were assessed in 326 patients; mild, moderate, and severe functional impairments were observed in 36, 26.4, and 3.7%, respectively. Absenteeism was detected in less than one third of patients with PsA, presenteeism was found in about half; there was an overall decrease in labor productivity in more than 60% and daily activity impairment in 68.8%. Statistically significant direct moderate correlations were established between the indicators of PsA activity (DAPSA and DAS28) and the level of productivity impairment in the patients; this was mostly related to an overall decline in labor productivity and to a decrease in daily activity.Conclusion. The data obtained from real clinical practice suggest that half of the PsA patients had high disease activity and a third had severe functional impairment, which led to a lower quality of life and to disability. The overall decrease in labor productivity and daily activity, which was detected in more than half of the patients, was associated with high PsA activity. The follow-up in the All-Russian PsA Registry, regular anti-inflammatory therapy with disease-modifying antirheumatic drugs and biological agents can improve the clinical and functional status and, consequently, working capacity in patients with PsA.
Objective – to study the effect of tofacitinib (TOFA) on Patient-Reported Outcomes (PROs) in psoriatic arthritis (PsA) patients (pts) activity in real clinical practice.Material and methods. Included 41 patients, predominantly men (58.9%), with a reliable diagnosis of psoriatic arthritis (PsA) according to the CASPAR criteria (2006), and signed informed consent to participate in the study. Mean age – 43.0±10.1 years, PsA duration – 18.6±10.4 years, psoriasis duration – 7.7±7.1 years, disease activity according to DAPSA (Disease Activity in Psoriatic Arthritis) – 44.2±17. At the initial visit, after 3 and 6 months, all patients underwent a standard rheumatological examination. The tender joint number (TJN) out of 68, the swollen joints number (SJN) out of 66 were evaluated, the DAPSA index was calculated, C-reactive protein (CRP, mg/dL), ESR (mm/h), patients with enthesitis and dactylitis in %. The prevalence and severity of psoriasis was determined by BSA (Body Surface Area). Among PROs, the severity of joint pain and disease activity were assessed according to the patient’s opinion of patient global assessment (PtGA) and pain using the visual analogue scale VAS (0–100 mm, respectively), HAQ, RAPID-3, DLQI, PsAID-12. All patients included in the study were prescribed TOFA 5 mg twice a day, followed by a possible increase in the dose to 10 mg twice a day. Also, after 3 and 6 months from the start of therapy, the PASS index (Patient-Acceptable Symptom State) was evaluated, i. e. symptom score below which the patient considers himself healthy, which corresponds to a total PsAID-12 score˂ 4 points and minimal clinically significant improvement (MCID, Minimal Clinical Improvement Disease – change in total PsAID-12 by 3 points).Results. In the whole group, DAPSA was 44.2±17.1, most patients (87.8%) had high PsA activity. By month 3/6 of follow-up, DAPSA significantly decreased to 15.2±12.4/11.8±9.4 (for all p<0.0001). By month 3/6 of TOFA therapy, there was a significant positive trend in all PROs (PtGA Pain, PtGA, BASDAI, HAQ, RAPID-3, FACIT-F, DLQI). Prior to therapy, PsAID-12 was 5.18±2.14. By month 3/6, PsAID-12 significantly decreased to 2.07±1.65/1.68±1.48 (for all p><0.0001). By the 6th month of therapy, MCID was noted in 90.2% of patients. Prior to the start of therapy, PASS was observed in 25.6% of patients. By month 3/6, the number of patients achieving PASS significantly increased to 66.7/71.8%, respectively (for all p><0.0001). By month 3/6 of TOFA therapy, there was a significant positive trend in all PROs (PtGA Pain, PtGA, BASDAI, HAQ, RAPID-3, FACIT-F, DLQI). Prior to therapy, PsAID-12 was 5.18±2.14. By month 3/6, PsAID-12 significantly decreased to 2.07±1.65/1.68±1.48 (for all p<0.0001). By the 6th month of therapy, MCID was noted in 90.2% of patients. Prior to the start of therapy, PASS was observed in 25.6% of patients. By month 3/6, the number of patients achieving PASS significantly increased to 66.7/71.8%, respectively (for all p><0.0001). By the 6th month of therapy, MCID was noted in 90.2% of patients. Prior to the start of therapy, PASS was observed in 25.6% of patients. By month 3/6, the number of patients achieving PASS significantly increased to 66.7/71.8%, respectively (for all p<0.0001).Conclusion. TOFA therapy for 6 months leads not only to a significant decrease in PsA activity, but also to an improvement in overall health according to the patient, assessed by PROs scales and questionnaires (PtGA Pain, PtGA, BASDAI, HAQ, RAPID-3, FACIT-F, DLQI). Dynamics of PsAID-12 shows the achievement of MCID in most patients. Positive dynamics is observed already by the 3rd month of treatment.
Psoriatic arthritis is a heterogeneous chronic in ammatory disease with a wide range of clinical manifestations and variants of course. For its treatment, non-steroidal anti-in ammatory drugs, glucocorticosteroids, basic anti-in ammatory drugs, targeted synthetic basic anti-in ammatory drugs, genetically engineered biological drugs are used. One of the representatives of the latter is ustekinumab. Ustekinumab-fully human monoclonal antibodies to interleukin 12/23p40-belonging to the G1 class immunoglobulins. e article considers the use of ustekinumab in patients with psoriatic arthritis. Positive dynamics of the disease symptoms was noted on the background of such treatment.
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