Comparison of disease activity measures in early psoriatic arthritis in usual care

Abstract

Objectives To compare responsiveness and longitudinal validity of Disease Activity Score 28 (DAS28), Disease Activity index for PSoriatic Arthritis (DAPSA), Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic ArthritiS Disease Activity Score (PASDAS), GRAppa Composite scorE (GRACE) and Minimal Disease Activity (MDA) in usual care PsA patients, within 1 year after diagnosis. Methods Data collected in the Dutch southwest early PsA cohort (DEPAR) were used. Responsiveness was assessed using effect size (ES), standardized response mean (SRM), and discrimination between different general health states. Longitudinal validity was tested using mixed models with outcomes health-related quality of life (HRQOL), productivity and disability. Results Responsiveness was highest for PASDAS, with ES 1.00 and SRM 0.95, lowest for DAPSA, with ES 0.73 and SRM 0.71, and in between for DAS28, CPDAI and GRACE. Differences in general health were best discriminated with PASDAS and GRACE. Patients reporting stable or worsening general health could not be distinguished by DAS28 or CPDAI. Discrimination was better using DAPSA, but worse than when using PASDAS and GRACE. Longitudinal evolvement of HRQOL and productivity had the highest association with low disease activity according to GRACE, followed by PASDAS, MDA, DAPSA, DAS28, with the lowest association for CPDAI. Conclusion PASDAS and GRACE were superior with respect to responsiveness, and together with MDA best related to longitudinal evolvement of HRQOL, productivity and disability. Responsiveness and longitudinal validity of most outcomes were inferior for DAS28, DAPSA and CPDAI. As alternatives to the continuous measure DAPSA, use of PASDAS or GRACE should be considered.

Measuring Outcomes in Psoriatic Arthritis

“…DAPSA has good responsiveness to change in trials and is able to differentiate between drug and placebo (101,108,115,119), but the effect size is lower than that of the PASDAS in most trial post hoc analyses (101,119,120). DAPSA has lower responsiveness than other composite disease measures in LOS (121). No differentiation was seen in two active comparator studies, including the recent SEAM‐PsA trial (111,122).…”

“…The CPDAI has good responsiveness to change and differentiates between drug plus placebo (101,108,119) and active comparators (122,127). It also has good responsiveness in LOS (121). The effect size is smaller than that for the PASDAS (101,119,120) in clinical trial post hoc analysis.…”

“…The effect size is usually highest of the newer composite measures (compared with DAPSA, CPDAI, and GRAPPA Composite Exercise [GRACE]) (101,119). The PASDAS has good responsiveness in LOS (121).…”

“…The effect size is usually only second to that of the PASDAS when compared with other composite measures (101,119,120). GRACE has good responsiveness in LOS (121).…”

The first results of a 6-year follow-up study of a patient with early psoriatic arthritis treated with a treat-to-target strategy

“…В основе этой стратегии лежит строгий контроль за результатами лечения и своевременное изменение тактики терапии в зависимости от достижения или недостижения ее основных целей -ремиссии или минимальной активности болезни (МАБ) [6,7]. В соответствии с основными дефинициями стратегии Т2Т состояние ремиссии при ПсА считается достигнутым при значении индекса активности DAPSA (Disease Activity In Psoriatic Arthritis) ≤4, а МАБ -при наличии 5 из 7 следующих критериев: число болезненных суставов (ЧБС) ≤1, число припухших суставов (ЧПС) ≤1, PASI (Psoriasis area and severity index) ≤1 или BSA (Body Surface Area) ≤3, оценка боли пациентом (ОБП) ≤15 мм, общая оценка заболевания пациентом (ОЗП) ≤20 мм, HAQ (Health assessment questionnaire) ≤0,5, число воспаленных энтезисов ≤1 [8].…”