Residual Disease Activity and Associated Factors in Psoriatic Arthritis

Abstract

Objective Remission or low disease activity should be the treatment target of psoriatic arthritis (PsA). However, residual disease activity (RDA) in some domains could persist. The aim of this study was to assess RDA and its associated factors in a group of patients with PsA. Methods Patients with PsA were enrolled if they satisfied ClASsification for Psoriatic ARthritis (CASPAR) criteria with > 6 months’ followup and achieved a status of low disease activity (LDA), minimal disease activity (MDA), or remission [Disease Activity Index for PsA (DAPSA) remission or very low disease activity (VLDA)]. RDA was assessed by the percentage of patients who had, although in LDA or remission, tender and/or swollen joints > 1, Leeds Enthesitis Index > 1, Health Assessment Questionnaire > 0.5, Psoriasis Area Severity Index (PASI) > 1, patient’s global assessment > 20, physician visual analog scale (VAS) > 20, and VAS pain > 15. Associated factors of RDA were also assessed. Results Of 113 enrolled patients, 78 (69%) were in MDA. Moreover, DAPSA remission was observed in 46 (40.7%) while VLDA only in 32 (28.3%) of patients with PsA. VLDA seems to be the most stringent criterion, with a minimal RDA only in the VAS physician in 1 patient (3.1%) and none in the different domains, while patients in MDA had RDA in tender joints (14.1%), VAS pain (29.4%) and PASI > 1 or body surface area (BSA) > 3% (17.9%). Of note, although patients in DAPSA remission show a very low rate of RDA in almost all domains, 12 (26%) of them show a PASI > 1 or BSA > 3%. Finally, LDA shows RDA in higher percentages, mainly in patient-reported outcomes, tender joints, and skin domain. Conclusion RDA can be recognized in patients with PsA. VLDA seems to be the most stringent composite index to identify patients in the absence of RDA.

Patient Perceptions of Psoriatic Arthritis Management and Communication with Physicians in Australia: Results from a Patient Survey

“…The working group also highlighted that HCPs and patients may have different perceptions of the meaning of disease remission. Notably, some patients who are determined to be in a state of remission, LDA, or minimal disease activity can have residual disease activity, which may present as pain, functional impairment, joint tenderness, or other clinical manifestations [ 20 ]. Focusing on patients’ treatment goals and enhanced patient–HCP communication were recommended by the working group for improving clinical outcomes for patients with PsA [ 10 ].…”

Measuring Outcomes in Psoriatic Arthritis

“…MDA reflects key domains of PsA encompassing the core outcome set of 2008 (99) and correlates well with patient and physician opinion of disease control (100). Low levels of residual active disease were found among patients in MDA (101–106). There is good correlation with other multidomain measures (101,102,107).…”

New Insights in Physical Therapy and Rehabilitation in Psoriatic Arthritis: A Review

“…For example, in the very recent SELECT-PsA 2 trial, the percentage of enrolled patients who were not responders or intolerant to ≥ 3 biologics ranged between 11 and 16%, representing a potential disease management issue [ 9 ]. Furthermore, the complexity of PsA may lead to the presence of residual disease activity in different domains, and some studies have shown how residual pain, impaired function and decreased quality of life could contribute to disease burden [ 10 ].…”