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

Gorlier, Clémence; Orbai, Ana Maria; Puyraimond-Zemmour, Déborah; Coates, Laura C.; Kiltz, Uta; Leung, Ying Ying; Palominos, Penélope Esther; Cañete, Juan D.; Scrivo, Rossana; Bălănescu, Andra; Dernis, Emmanuelle; Tälli, Sandra; Ruyssen‐Witrand, Adeline; Soubrier, Martin; Aydın, Sibel Zehra; Eder, Lihi; Gaydukova, I.; Lubrano, Ennio; Kalyoncu, Umut; Richette, Pascal; Husni, M. Elaine; Wit, Maarten de; Smolen, Josef S.; Gossec, Laure

doi:10.1136/annrheumdis-2018-214140

Cited by 68 publications

(58 citation statements)

References 49 publications

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“…On the contrary, the best agreement was seen between cDAPSA remission and PASS. In this sense, our findings are quite consistent with those of the recently published ReFlap (Remission/Flare in PsA) study [16]. In ReFlap, adults with physician-confirmed PsA and > 2 years of disease duration in 14 countries were included.…”

Section: Discussionsupporting

confidence: 91%

“…In this study, DAPSA-based remission/low disease activity (LDA) performed better than VLDA/MDA to detect patient defined remission or remission/LDA. Further, physicianperceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions [16]. Which are the drivers of this discordance between patient-perceived remission, or low impact of disease, and physician-defined remission?…”

Section: Discussionmentioning

confidence: 99%

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Disease features associated with a low disease impact in patients with psoriatic arthritis: results of a cross-sectional multicenter study

et al. 2020

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on behalf of the MAAPS study groupAbstract Background: Patient-reported outcomes measures, such as those provided by the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, have been found to be a reliable indicator of change during treatment, predictive of long-term outcomes, and the impact of psoriatic arthritis (PsA) on patients' lives. The objective of the study was to describe the demographic and clinical characteristics of PsA patients with a low disease impact and to analyze predictive factors for that state. Methods: Post hoc analysis of a cross-sectional multicenter study that included 223 consecutive patients. PsAID questionnaire was used to estimate disease impact. Patients with a PsAID < 4 were considered in low disease impact. Minimal disease activity (MDA) response and the Health Assessment Questionnaire (HAQ) were also assessed. The degree of agreement between the different outcomes was addressed by Cohen's kappa index. Results: One hundred and twenty-two (54.7%) patients reached a PsAID < 4. Among them, 52.0% and 68.0% presented articular or skin remission, respectively. Almost 75% of patients were in MDA state and 85.2% presented a low disability state according to the HAQ. A moderate concordance between HAQ ≤ 0.5 and PsAID < 4 (k = 0.53), fair between MDA and PsAID < 4 (k = 0.36), and moderate between DAPSA remission and PsAID < 4 (k = 0.46) was observed. Multivariate logistic regression analysis showed that patients with distal interphalangeal joint (DIP) disease (OR 0.40, 95%CI, 0.20-0.79, p = 0.009), family history of PsA (OR 0.25, 95%CI, 0.09-0.72, p = 0.010), and higher Creactive protein (OR 0.92, 95%CI, 0.85-0.99, p = 0.036) were significantly less likely to reach a PsAID < 4. Conclusions: There is certain discrepancy between disease activity measures and a low impact of disease in PsA. Clinical features (DIP joint involvement), biologic activity, and genetic factors (familial history) seem to be associated with lower odds of reaching a low disease impact.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Disease features associated with a low disease impact in patients with psoriatic arthritis: results of a cross-sectional multicenter study

et al. 2020

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“…Moreover, the good sensitivity and specificity of PASS with respect to PsAID can be explained by the fact that both instruments are based on ‘subjective’ domains more than ‘objective’ ones, underlining that both instruments may capture the patient's perception of the disease. In this context, a similarity between PASS and patient-perceived low disease activity in the REFLAP study can be found 31. In conclusion, this study showed that PASS might be used as an alternative for assessment of low disease activity and overall disease status in patients with PsA in real clinical practice.…”

Section: Discussionsupporting

confidence: 62%

Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices

et al. 2020

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ObjectiveThe aim of this study was to evaluate the discriminant capability of the Patient Acceptable Symptom State (PASS) according to disease activity, remission/low disease activity indices and quality of life indices in patients with psoriatic arthritis (PsA).MethodsConsecutive patients with PsA were enrolled in this cross-sectional study. At each visit, the patients underwent a complete physical examination and their clinical/laboratory data were collected. Disease activity was assessed using the Disease Activity Score for Psoriatic Arthritis (DAPSA) and remission/low disease activity using the DAPSA minimal disease activity (MDA) and very low disease activity (VLDA) criteria. The Psoriatic Arthritis Impact of Disease (PsAID) and the Health Assessment Questionnaire-Disability Index scores were also collected. Finally, PASS was assessed by asking all patients to answer yes or no to a single question.ResultsPatients who answered yes to PASS showed a significantly better overall mean DAPSA score than those who were not in PASS. Furthermore, patients in PASS showed a significantly lower level of systemic inflammation, lower Leeds Enthesitis Index score, a significantly lower impact of disease (PsAID), lower pain and better function than patients who answered no to PASS. A moderate to good agreement was found between PASS, MDA, DAPSA low disease activity and PsAID score ≤4. Good sensitivity and specificity were found with PASS with respect to DAPSA low disease activity, and although PASS is sensitive in the identification of patients with MDA, DAPSA remission and VLDA it lacks of specificity.DiscussionThis study showed that PASS might be used as an alternative to determine disease activity in patients with PsA in real clinical practice, mainly in patients with low disease activity according to DAPSA criteria.

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“…33 34 Remission in PsA is difficult to define. 33 Remission should be seen as abrogation of inflammation.…”

Section: Newmentioning

confidence: 99%

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

et al. 2020

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ObjectiveTo update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA).MethodsAccording to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined.ResultsThe updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed.ConclusionThese recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.

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

Cited by 68 publications

References 49 publications

Disease features associated with a low disease impact in patients with psoriatic arthritis: results of a cross-sectional multicenter study

Disease features associated with a low disease impact in patients with psoriatic arthritis: results of a cross-sectional multicenter study

Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices

EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

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