Impact of skin, musculoskeletal and psychosocial aspects on quality of life in psoriatic arthritis patients: A cross-sectional study of outpatient clinic patients in the biologic treatment era

Abstract

BackgroundIn psoriatic arthritis (PsA), both psoriasis and musculoskeletal manifestations may impair Health-Related Quality of Life (HRQoL). Our objective was to explore the impact of the various disease manifestations and disease consequences, including psychosocial factors, on HRQoL in PsA patients treated in the biologic treatment era.MethodsData collection in the 131 outpatient clinic PsA patients assessed included demographics, disease activity measures for both skin and musculoskeletal involvement and patient-reported outcome (PRO) measures, treatment and psychosocial burden. The skin dimension of quality of life was assessed by the Dermatology Life Quality Index (DLQI) and the overall HRQoL by the 15-Dimensional (15D) Questionnaire.ResultsThe mean age was 51.9 years, PsA disease duration 8.6 years, 50.4% were men, 56.9% were employed/working and 47.7% had ≥1 comorbidities. Prevalence of monotherapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was 36.6% and with biologic DMARDs 12.2% and combination of both 22.9%. Mean DLQI was 3.3 and 15D 0.84. In adjusted analysis, not employed/working, higher scores for fatigue, sleep disturbances, anxiety and depression, Modified Health Assessment Questionnaire and presence of comorbidities were independently associated with impaired HRQoL (lower 15D scores), whereas Psoriasis Area Severity Index (PASI) and DLQI were not. Younger age and higher Psoriatic Arthritis Disease Activity Score and PASI scores were independently associated with impaired skin quality of life (higher DLQI score).ConclusionOur study highlights the negative impact the psychosocial burden, impaired physical function and comorbidities has on reduced HRQoL in PsA outpatients. Thus, to further improve HRQoL in PsA patients, not only physical concerns but also psychological concerns need to be addressed.

Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates

“…In the present study, we wanted to explore the single elements that may impact sleep, fatigue, and depression in PsA. Thus, we excluded HRQoL measures, composite disease activity scores, and global scores both investigator and patient global assessment which previously has been reported [11,13].…”

Guselkumab in psoriatic arthritis: a profile of its use

“…May ↑ risk of infection Do not initiate in pts with any clinically important active infection until it has resolved or been adequately treated (EU, USA); consider risks and benefits before initiating in pts with a chronic infection or past recurrent infection (USA) Instruct recipients to seek medical advice if they experience signs/symptoms of a clinically important infection (chronic or acute); closely monitor any pt who develops a serious or clinically important infection (or is not responding to standard therapy) and discontinue guselkumab until infection [20,21]. Patients with psoriatic arthritis typically report reduced HR-QOL relative to the general population [33], with contributing factors including the psychosocial burden, impaired physical function and comorbidities associated with the condition [34]. Guselkumab provides durable clinical benefits based on results through two years of treatment in clinical trials [23,30].…”

Introduction and switching of biologic agents are associated with antidepressant and anxiolytic medication use: data on 42 815 real-world patients with inflammatory rheumatic disease

“…Interestingly, increased peripheral inflammatory markers were more common among anti-depressant non-responders compared with responders. 8 Furthermore, it is well 2846 (28) 3813 2531 291 257 226 174 215 (2) Other csDMARDs (%) 205 (11) 703 (7) 649 4382 (27) 929 (21) 366 (14) 166 (8) 292 (8) 74 7bDMARDs (17) 1554 (15) 2095 (14) 338 (24) 972 (22) 409 (16) 180 (8) 410 (11) 97 (10) Glucocorticoids (%) (12) 2394 (23) 3988 (26) 143 (10) 834 (19) 591 (23) 235 (11) 673 (18) 208 (21) bDMARD, biologic DMARD; cDMARD, conventional synthetic DMARD; DMARD, disease modifying anti-rheumatic drugs; TNF, tumour necrosis factor. 281 (6) 310 (5) 193 (17) 370 (12) 134 (10) 406 (20) 471 (14) 119 (13) Female (%)…”

“…So far, metaanalyses and cohort studies have shown higher odds for depression among patients with RA, PsA and AS [19][20][21][22] compared with the general population. Depression in rheumatic diseases has been associated with impaired health-related quality of life, 23 worse response to treatment and lower improvement in disease activity over time. 8 12 24 Only few small cohort studies have directly compared the OR of depression between different IRDs, reporting an equal probability between patients with AS and RA 25 and a higher probability in patients with PsA compared with RA.…”