Patients with Psoriatic Arthritis Fulfilling the Minimal Disease Activity Criteria Do Not Have Swollen and Tender Joints, but Have Active Skin

Marín, Josefina; Felquer, María Laura Acosta; Garrot, Leandro Ferreyra; Ruta, Santiago; Rosa, Javier; Soriano, Enrique R.

doi:10.3899/jrheum.151101

Cited by 17 publications

(18 citation statements)

References 16 publications

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“…Pain was also the most commonly unmet MDA criterion in a study from the Biologic Treatment Registry Across Canada registry [ 22 ]. The influence of pain on therapeutic response in PsA is consistent with findings from our study of patients with RA, in which pain showed a high correlation with therapeutic response as assessed by DAS28 [ 23 ], and with a recent study of 83 patients with PsA who presented to a hospital clinic in Argentina, which also found that the pain score criterion was the least likely to be achieved (29% of patients overall and 56% of patients with MDA) [ 24 ]. In contrast, BSA ⩽3% and enthesitis showed only low correlations with MDA and did not correlate well with other MDA criteria.…”

Section: Discussionsupporting

confidence: 89%

Minimal disease activity is a stable measure of therapeutic response in psoriatic arthritis patients receiving treatment with adalimumab

et al. 2018

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ObjectiveThe aim of this study was to evaluate minimal disease activity (MDA) assessments in patients with PsA during routine clinical care.MethodsWe used data from a multicentre observational study of patients with active PsA who initiated treatment with adalimumab during routine clinical practice and continued treatment for at least 6 months to evaluate achievement of MDA, individual MDA criteria (modified to conform to study assessments) and ACR responses during 24 months of therapy. Pearson correlation coefficients were used to evaluate the association between MDA and individual criteria at month 6; regression models were used to determine the influence of baseline MDA criteria on achievement of MDA at month 6.ResultsA total of 1684 patients were included in these analyses; most had long-standing disease. MDA was achieved by 597 patients (35.5%) at month 6. This proportion increased to 45.5% at month 24 in patients remaining on therapy. MDA status was stable over time; >75% of patients with MDA at month 6 recorded MDA at subsequent visits. Pain was the most difficult individual criterion to achieve, and enthesitis was the least difficult. Higher functional status and fewer tender joints at baseline predicted achievement of MDA at month 6. About half of patients (51.5%) with an ACR20 response at month 6 achieved MDA.ConclusionIn this observational cohort of patients with long-standing disease, MDA provided a stable and valid assessment of clinical status over 24 months.Trial registrationClinicaltrials.gov, https://clinicaltrials.gov, NCT01111240

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Section: Discussionsupporting

confidence: 89%

Minimal disease activity is a stable measure of therapeutic response in psoriatic arthritis patients receiving treatment with adalimumab

et al. 2018

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“…A previous study reported a highly active skin component still present in patients otherwise meeting MDA criteria; however, details of PsA therapy were not presented. 15 …”

Section: Discussionmentioning

confidence: 99%

“… 14 However, the attainment of individual MDA components in MDA achievers has not been extensively evaluated. 15 Identification of MDA components that are difficult to achieve may ascertain clinical or pathological factors that merit future attention in disease management strategies. Additionally, there is limited understanding of patient and disease characteristics that predict MDA achievement over longer term and of other potential benefits associated with achievement of MDA.…”

Section: Introductionmentioning

confidence: 99%

Prediction and benefits of minimal disease activity in patients with psoriatic arthritis and active skin disease in the ADEPT trial

et al. 2017

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ObjectivesTo determine the proportion of patients with psoriatic arthritis in the Adalimumab Effectiveness in Psoriatic Arthritis trial achieving minimal disease activity (MDA) and its individual components at 1 or more visits over 144 weeks, identify baseline predictors of MDA achievement, and evaluate the association of MDA status with independent quality of life (QoL)-related patient-reported outcomes (PROs).MethodsUnivariate and multivariate analyses were used to identify the baseline characteristics that predicted achievement of MDA at individual time points (weeks 12 through 144) or sustained MDA (achievement of MDA at 2 consecutive time points 12 weeks apart). The association of independent QoL-related PROs with MDA achievement was evaluated at weeks 24 and 144.ResultsIn univariate analyses, higher baseline patient assessment of pain, tender joint count (TJC), enthesitis and Health Assessment Questionnaire-Disability Index (HAQ-DI) score were significantly associated with lower likelihood of achieving MDA at later time points. Multivariate analyses confirmed higher baseline HAQ-DI as a significant predictor for failure to achieve MDA at later time points. Achievement of sustained MDA was associated with lower baseline TJC and HAQ-DI score. Achievement of different MDA components appeared to be treatment dependent. MDA achievers had significantly better QoL-related PROs and greater improvements in PROs from baseline to week 24 compared with non-achievers.ConclusionsHigher HAQ-DI score was the most consistent baseline factor that decreased the likelihood of achieving MDA and sustained MDA at later time points. Achieving MDA was associated with better independent QoL-related PROs.

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“…In registries and observational studies, demographic characteristics such as younger age and male sex, lower functional impairment at baseline (assessed by the Bath Ankylosing Spondylitis Functional Index and HAQ), low disease activity at baseline, and other factors such as shorter symptom duration and greater general well-being (assessed by global VAS) have been reported as predictors of achieving MDA upon treatment with TNF inhibitors 24,26,31,32 .…”

Section: Predictors Of Achieving Mdamentioning

confidence: 99%

Minimal Disease Activity as a Treatment Target in Psoriatic Arthritis: A Review of the Literature

et al. 2017

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As in other inflammatory rheumatic diseases, the objective of psoriatic arthritis (PsA) treatment is the achievement of a defined target. Recent recommendations propose aiming for remission or low disease activity; however, a consensual definition of remission is lacking. A state of minimal disease activity (MDA) has been established and is defined by low activity assessed by tender/swollen joint counts, tender entheseal points, Psoriasis Area and Severity Index or body surface area, patient pain and global activity visual analog scale, and functional evaluation by Health Assessment Questionnaire. Since its development, MDA has been used increasingly in studies and clinical trials. In this article, the potential use of MDA as a treatment target in PsA is reviewed. The frequencies of MDA achievement with biologic disease-modifying antirheumatic drugs are summarized based on data from registries, observational studies, and clinical trials. Predictors and the prognostic effect of attaining MDA are also evaluated.

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Patients with Psoriatic Arthritis Fulfilling the Minimal Disease Activity Criteria Do Not Have Swollen and Tender Joints, but Have Active Skin

Abstract: A minority of patients with PsA fulfilling the MDA criteria presented active joints, but half had active skin. Visual analog scale scores and the PASI prevented patients from achieving MDA.

Cited by 17 publications

References 16 publications

Minimal disease activity is a stable measure of therapeutic response in psoriatic arthritis patients receiving treatment with adalimumab

Minimal disease activity is a stable measure of therapeutic response in psoriatic arthritis patients receiving treatment with adalimumab

Prediction and benefits of minimal disease activity in patients with psoriatic arthritis and active skin disease in the ADEPT trial

Minimal Disease Activity as a Treatment Target in Psoriatic Arthritis: A Review of the Literature

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