Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study

Abstract

BackgroundPatients with psoriatic arthritis (PsA) experience functional impairment and reduced quality of life, and thus patient global assessment in PsA is explained mainly by the physical, but also by the psychological, aspect of the disease. To assess the prevalence of minimal disease activity (MDA) in Spanish patients with PsA, we examined their characteristics and the association between MDA and the impact of the disease as assessed by the PsA Impact of Disease (PsAID) questionnaire.MethodsA cross-sectional multicenter study was carried out in patients who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least 1 year of disease duration, and who were treated with biological or conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) according to routine clinical practice in Spain. Patients were considered in MDA if they met at least 5/7 of the MDA criteria. The association between MDA and the recently developed PsAID questionnaire was also recorded.ResultsOf 227 patients included, 133 (58.6%) were in the MDA state (52% with antitumor necrosis factor (anti-TNF)α monotherapy, 24% with csDMARD monotherapy, and 24% with anti-TNFα in combination with csDMARD). Using multivariate logistic regression analysis, male gender (odds ratio (OR) 2.74, p = 0.001), a sedentary lifestyle (OR 3.13, p = 0.002), familial history of PsA (OR 0.38, p = 0.036), C-reactive protein (CRP) level (OR 0.92, p = 0.010), and use of corticoids (OR 0.33, p = 0.007) were considered features related to MDA. MDA patients had a significantly lower impact of the disease according to PsAID (mean total score (SD): MDA 3.3 (3.1) vs. non-MDA 7.1 (5.2); p < 0.001).ConclusionsNearly 60% of Spanish PsA patients achieve MDA in routine clinical practice. MDA remains one of the most useful therapeutic targets for PsA since patients who reached this state also had a significantly lower impact of disease according to PsAID.

Prevalence of minimal disease activity in Australian patients with Psoriatic Arthritis: Assessing the outcome of national funding criteria for biologic disease‐modifying antirheumatic drug prescribing

“…The lack of difference between inflammatory marker levels for the PsA and RA cohorts when they qualified for biologics is surprising (Table ), but again reflects the criteria used to select these patients. Our study supports the observation of high ESR and CRP being predictors of MDA in bDMARD studies, as 73% of our biologics clinic PsA patients achieved MDA from a point of very active disease. This figure is higher than a Spanish real‐world cohort of 52%, two Italian cohorts of 66% and 60.3% respectively, and also exceeds that of most of the bDMARD clinical trials .…”

“…Our study supports the observation of high ESR and CRP being predictors of MDA in bDMARD studies, as 73% of our biologics clinic PsA patients achieved MDA from a point of very active disease. This figure is higher than a Spanish real‐world cohort of 52%, two Italian cohorts of 66% and 60.3% respectively, and also exceeds that of most of the bDMARD clinical trials . This suggests that the Australian PBS criteria are specific in their selection of good responders.…”

“…In our PsA cohort, 53% of patients achieved MDA, a figure consistent with other real‐world cohorts . It is of note that there was no difference between the biologic clinic PsA and RA patient cohorts in terms of the pattern of active joints at the time they qualified for a bDMARD (Table ).…”

Burden of Psoriatic Arthritis According to Different Definitions of Disease Activity: Comparing Minimal Disease Activity and the Disease Activity Index for Psoriatic Arthritis

“…Investigators in other studies did assess the burden of disease in patients fulfilling only 1 of the targets compared with those not fulfilling that target. It was shown in those studies that patients achieving the target had better scores for patient-reported outcomes compared with patients in whom the target was not achieved (28)(29)(30)(31).…”

Disease features associated with a low disease impact in patients with psoriatic arthritis: results of a cross-sectional multicenter study

“…This was a post hoc analysis of data from an observational, multicenter, cross-sectional study carried out at twenty-five rheumatology outpatient clinics in the whole of Spain [11].…”