SAT0318 Do patients in remission in psoriatic arthritis, have less fatigue? and does this depend on the definition of remission? an analysis of 304 patients

Abstract

BackgroundFatigue is a critical element of life impact for patients with Psoriatic Arthritis (PsA) and is not considered in remission definitions. In PsA, remission can be defined using composite scores (Minimal Disease Activity (MDA), Disease Activity in PSoriatic Arthritis (DAPSA)≤4), Patient Acceptable Symptom State (PASS), Patient Global Assessment (PGA)(for example ≤1/10), or as a single for remission item.ObjectivesTo explore the relationship between fatigue and remission in PsA, when using different definitions of remission.MethodsReFlaP (NCT03119805) is a cross-sectional study in 14 countries of consecutive adult patients with definite PsA and more than 2 years of disease duration. Patient-perceived fatigue was assessed by a 11-point numerical rating scale. Remission status was defined from the physician’s perspective as MDA, DAPSA≤4 and physician-perceived remission (single question yes/no), and from the patient’s perspective as PASS, PGA ≤1 and patient-perceived remission (single question yes/no). We calculated fatigue group means and deltas by remission status and compared these by Student’s t test. For known groups validity of each remission definition we used ROC curves and corresponding areas under the curve (AUC).ResultsOf 366 patients, 304 had both fatigue and remission data available: 148 (49.8%) were male, mean age was 53.9±12.3 years, mean disease duration was 10.8±7.7 years; 90.3% had predominant peripheral disease, 56.3% were taking methotrexate, 66.5% a biologic and 19.4% oral glucocorticoids. Disease activity was moderate: 41.1% had no current psoriasis skin lesions, mean Tender Joint Count (TJC) was 4.3±8.9, mean Swollen Joint Count (SJC) was 2.66±8.3, mean Physician’s global assessment was 3.0±2.4, mean PGA was 4.19%±2.7. 80.6% patients had DAPSA levels<28 (ie, remission, low or moderate disease activity).Mean patient’s assessment of fatigue was 4.26±3.0. The frequency of remission varied from 17.4% to 64.8% (the most stringent definition being DAPSA and the least PASS). Fatigue levels were much lower in remission than non-remission with group differences in fatigue ranging from 1.66±0.3) (Physician remission single question yes/no) to 3.81±0.3 (DAPSA remission) (all p<0.0001) (figure 1). Corresponding AUCs ranged from 0.66 (Physician’s remission question) to 0.87 (DAPSA).ConclusionsFatigue levels were relatively high in these PsA patients whose disease was often well-controlled. Fatigue was lower in patients in remission, according to all definitions of remission; the remission definition with best known-groups validity for fatigue was DAPSA remission. Moreover both composite measures perform better than the physicians opinion of remission. These elements may be important in a context of shared decision-making.AcknowledgementsThis study was funded by Pfizer.Disclosure of InterestNone declared

Disease Features Associated with a low Disease Impact in Patients with Psoriatic Arthritis: Results of a Cross-Sectional Multicenter Study

“…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.…”

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

Sex-Specific Differences in Patients With Psoriatic Arthritis: A Systematic Review

“…15 In total, 5 included studies were retrospective observational studies, [24][25][26][27][28] and 9 were cross-sectional studies. [29][30][31][32][33][34][35][36][37] Only 1 study was reported as a qualitative research study 38 and, finally, 1 study was reported as a population-based cohort study. 39 Population size varied greatly across the included studies, from 108 patients 14 to 8677 patients 25 (Supplementary Table S7, available with the online version of this article).…”

“…PsA-specific measures may represent a better way to illustrate sex-specific differences in the experience of the disease; however, they were employed only in 6 included studies. [18][19][20]29,30,36 Further, it is important to consider that although PROs can capture levels of self-reported physical function, the source of pain or reason for the functional impairment cannot be known in detail. In order to better capture the impact of disease on patients and pursue the most relevant improvements in clinical outcomes, qualitative patient interviews might be a useful way to explore sex-specific differences in PsA.…”