Burden of Psoriatic Arthritis According to Different Definitions of Disease Activity: Comparing Minimal Disease Activity and the Disease Activity Index for Psoriatic Arthritis

Abstract

Objective Treat‐to‐target strategies have improved outcomes in rheumatic diseases. In psoriatic arthritis (PsA), the proposed targets are the multidimensional target minimal disease activity (MDA) and the articular target Disease Activity index for PsA (DAPSA). The aim of this study was to compare the disease burden of PsA in patients with low disease activity according to the 2 definitions, MDA and DAPSA low disease activity (DAPSA‐LDA), 1 year after diagnosis. Methods We obtained data on MDA, DAPSA‐LDA and disease burden 1 year after diagnosis for patients included in the Dutch southwest early PsA cohort. Disease burden was assessed in 2 domains: “Body functions,” including the Short Form 36 bodily pain (SF‐36 BP) measure, and “Activity,” including the Health Assessment Questionnaire (HAQ). Results Among the 292 patients included, 48% achieved MDA and 74% achieved DAPSA‐LDA. Average scores for Body functions and Activity were better in patients who achieved MDA and those who achieved DAPSA‐LDA. The scores were significantly better in the 46% of patients who achieved both MDA and DAPSA‐LDA than in the 29% of patients who achieved only DAPSA‐LDA. The average SF‐36 BP score was higher in patients achieving both targets (73.8; 95% confidence interval [95% CI] 71.1‐76.5) than in patients achieving only DAPSA‐LDA (57.6; 95% CI 54.5‐60.8). Similarly, mean HAQ scores measuring Activity were 0.21 (95% CI 0.15‐0.26) and 0.63 (95% CI 0.53‐0.72), respectively. Conclusion Among patients with newly diagnosed PsA, 48% achieved MDA and 74% achieved DAPSA‐LDA after 1 year of receiving usual care. The average disease burden was better in patients who achieved MDA and those who achieved DAPSA‐LDA. Also, patients who achieved only DAPSA‐LDA reported worse outcomes than those who also achieved MDA.

Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries

“…In the present study, we confirmed that the frequency of REM and LDA was very variable according to the definition used, and in particular REM and LDA were more difficult to reach using VLDA/MDA than DAPSA-based cut-offs, as has been previously reported 14–16. This may be because of the inclusion of diverse domains of PsA (and in particular skin involvement), or because of low cut-offs for each measure.…”

“…Nevertheless, it is generalisable due to the international large-scale recruitment strategy of consecutive patients with PsA. Furthermore, frequencies of REM/LDA were similar to other studies, which supports the validity of the present findings 14–16. Another difficulty was to choose among many possible definitions of REM/LDA since no consensus exists.…”

“…The psychometric properties of VLDA/MDA with Boolean features also make them more strict 38 49. Concerning agreements between these scores, kappas were also similar to the literature, with moderate agreement for REM but fair for LDA whatever the definition used 14 15…”

“…To this end we have used a unidimensional (DAPSA) and a multidimensional (MDA) instrument. Three recent studies have compared the VLDA/MDA outcomes with DAPSA outcomes in terms of frequency but did not assess the patient’s perspective in parallel 14–16…”

Achieving sustained minimal disease activity with methotrexate in early interleukin 23-driven early psoriatic arthritis

“…We used data collected in the Dutch southwest Early Psoriatic Arthritis cohoRt (DEPAR) study, of which details are described elsewhere. 10 In short, DEPAR collects data to investigate the daily clinical practice of patients with PsA. Patients with a new diagnosis of PsA are eligible to participate if they did not yet receive treatment with disease-modifying antirheumatic drugs (DMARDs) for PsA before the first study visit.…”