Residual Disease Burden in Patients With Axial Spondyloarthritis and Psoriatic Arthritis Despite Low Disease Activity States in a Multiethnic Asian Population

Abstract

Objective To evaluate the burden of residual disease in patients with axial SpondyloArthritis (axSpA) or Psoriatic Arthritis (PsA) who achieved low disease activity status. Methods We used baseline data from a clinic registry of SpA in a tertiary hospital in Singapore. For axSpA, LDA was defined as ASDAS-ESR <2.1 or BASDAI <3/10. For PsA, LDA was defined by achieving 5/7 cut-offs in the Minimal Disease Activity (MDA) or clinical Disease Activity index for Psoriatic Arthritis (cDAPSA) ≤13. Results From 262 cases of axSpA (21% women; mean ± standard deviation (SD) age 42 ± 14 years), 33% and 43% of patients achieved ASDAS-ESR and BASDAI LDA states respectively. While from 142 cases of PsA (49% women; mean ± SD age 51 ± 14 years), 35% and 63% achieved MDA and cDAPSA LDA, respectively. Both axSpA and PsA patients with LDA had pain scores range from 14.0 to 21.4/100 and fatigue scores from 3.1 to 3.6/10. Substantial burden in physical disability and mental wellbeing were observed with low physical and mental component summary of SF-36. AxSpa patients in BASDAI LDA had higher ESR and lower disability than those in ASDAS-ESR LDA. cDAPSA classified nearly twice as many PsA patients into LDA than MDA. Compared to PsA patients in MDA LDA, PsA patients in cDAPSA LDA had higher active joint counts, dactylitis, enthesitis, pain scores and patient global assessment (PtGA) Conclusion Despite being in LDA, patients with axSpA and PsA experienced substantial residual burden in pain, fatigue, poorer functional health and mental well-being.

Residual Disease in Patients with Axial Spondyloarthritis: A Post-Hoc Analysis of the QUASAR Study

“…It is possible that patients with EMMs underwent a more aggressive therapy with bDMARDs that resulted in better control of the rheumatic disorder. The association between the presence of EMMs and fatigue/tiredness is recognised [ 9 , 14 , 27 ], although we did not observe any obvious association. Further analysis involving a larger sample size in axSpA patients over time are needed to verify the role of EMMs in this context.…”

“…To our knowledge, only one other study to date has investigated the burden of residual disease in a population of patients with axSpA [ 14 ]. The 87 of 262 patients (33%) who achieved ASDAS-ESR LDA showed residual disease burden in musculoskeletal manifestations, as well as in pain, fatigue, PhGA scores, and mental health.…”

“…The ASQoL questionnaire measures the impact of axSpA on HRQoL from the patient perspective and includes 18 items [ 18 ]. Fatigue/tiredness are symptoms frequently seen in patients with inflammatory rheumatic diseases and can significantly impact their QoL [ 14 , 20 ]. Therefore, in this post-hoc analysis, we focused on three specific questions (questions 7, 8, and 12) related to tiredness/fatigue.…”

“…The most up-to-date tool used for the assessment of disease activity in axSpA is the Ankylosing Spondylitis Disease Activity Score (ASDAS), which defines LDA or inactive disease status scores of <2.1 and <1.3, respectively [ 12 , 13 ]. To date, few studies are available that have explored the burden of residual disease in axSpA patients with inactive disease or who have achieved LDA status, as per the ASDAS definition [ 14 ]. To address this unmet need, the aim of this post-hoc analysis of the Italian multicentre QUASAR study was to evaluate the presence of residual disease in patients with axSpA who had reached remission/low disease activity LDA status.…”

2022 French Society for Rheumatology (SFR) recommendations on the everyday management of patients with spondyloarthritis, including psoriatic arthritis

“…Regarding the evaluation of disease activity, the experts underlined the challenges posed by the coexistence of fibromyalgia [36][37][38] or residual pain/disease [39]. This combination creates diagnostic dilemmas and increases the disease activity scores, potentially resulting in over-treatment.…”