Patient’s experience of psoriatic arthritis: a conceptual model based on qualitative interviews

Abstract

IntroductionPsoriatic arthritis (PsA) is a heterogeneous chronic inflammatory musculoskeletal disorder that manifests as peripheral arthritis, dactylitis, enthesitis and spondylitis. PsA results in significant burden that impacts quality of life of patients. We examined the signs, symptoms and impacts reported by patients with PsA, to characterise the patient experience of PsA and develop a conceptual model representing this patient experience.MethodsSemi-structured interviews were conducted with patients with PsA recruited through the FORWARD databank. Spontaneous and probed signs, symptoms and impacts of PsA were assessed. Patients rated the disturbance of these concepts on their lives using a scale from 0 (‘does not disturb’) to 10 (‘greatly disturbs’). Signs, symptoms and impacts reported by >80% of patients with a disturbance rating of ≥5 were defined as salient concepts. Recruitment continued until concept saturation was achieved.Results19 patients with PsA were interviewed. The interviews elicited 42 symptoms of which 8 had not been identified in a previous literature review encompassing 15 relevant articles. The most salient signs and symptoms elicited in the interviews were joint pain, skin symptoms, stiffness, swollen/inflamed joints and fatigue all with moderate to high disturbance ratings (range: 5.5–7.8). The most salient impacts were sleep disturbance, physical disability, effects on daily activities and feelings of frustration with also moderate to high disturbance ratings (range: 6.1–7.4).ConclusionsThe interviews highlighted the adverse impact PsA has on the patient’s life and may inform on outcome variables or areas suitable to be assessed in PsA studies.

Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry

“…This study found that symptoms related to musculoskeletal pain were the most bothersome symptoms of PsA, compared with psoriasis-related symptoms, in rheumatology-focused patients with overall low skin disease severity. This finding mirrors other patient impact studies in PsA [3,16,28,29], and patients and rheumatologists are generally in agreement that joint pain is the most burdensome symptom of PsA [30]. However, our findings also highlight other interesting trends.…”

Use of IL-23 Inhibitors for the Treatment of Plaque Psoriasis and Psoriatic Arthritis: A Comprehensive Review

“…Pooled analysis of the DISCOVER trials found resolution of enthesitis by 45–50% of the guselkumab group compared with 29% of placebo and resolution of dactylitis by 59–64% of the guselkumab group compared with 42% of placebo; baseline scores were also significantly decreased after 24 weeks of treatment [ 69 ]. Similar efficacy in dactylitis and enthesitis was seen through 56 weeks in a phase II trial of patients with active PsA despite current or previous conventional therapy [ 70 ].…”

Patient-Reported Outcomes in Psoriatic Arthritis Patients with an Inadequate Response to Biologic Disease-Modifying Antirheumatic Drugs: SELECT-PsA 2

“…PROs reflect many important issues that significantly impact patients with PsA, including challenges in mental, physical, and social functioning, pain, fatigue, work-related disability, in addition to psoriatic, axial, and skin disease symptoms. Many of these symptoms and sequelae of disease are represented by the core domains recommended by the GRAPPA-OMERACT working group to be measured in all RCTs to evaluate treatment efficacy [2,3,18,[37][38][39][40]. In a recent qualitative interview study of PsA patients recruited through the FORWARD databank, joint pain and stiffness, skin symptoms, fatigue, and physical disability were identified as some of the most salient PsA symptoms [39].…”

“…Many of these symptoms and sequelae of disease are represented by the core domains recommended by the GRAPPA-OMERACT working group to be measured in all RCTs to evaluate treatment efficacy [2,3,18,[37][38][39][40]. In a recent qualitative interview study of PsA patients recruited through the FORWARD databank, joint pain and stiffness, skin symptoms, fatigue, and physical disability were identified as some of the most salient PsA symptoms [39]. Similarly, pain, fatigue, and poor HRQOL have been identified as some of the highest-ranking outcomes that patients would want treatment to remedy [40].…”