1
|
Tillett W, Birt J, Vadhariya A, Ross S, Ngantcha M, Ng KJ. Filling the "GAP" in Real-World Assessment of Psoriatic Arthritis Disease Activity: Performance Characteristics of a Global/Pain Composite Endpoint. Rheumatol Ther 2024:10.1007/s40744-024-00690-1. [PMID: 38955921 DOI: 10.1007/s40744-024-00690-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION Some retrospective data sources, such as electronic health records in the USA, report composite outcome measures not fully validated in psoriatic arthritis (PsA). However, they often contain global assessments, such as a Physician Global Assessment (PhGA) and Patient Global Assessment (PatGA), along with patient-reported pain scores, which individually are considered validated in PsA. This research described the performance characteristics of a 3-item global assessment and pain (GAP) composite endpoint using data from the ixekizumab phase 3 PsA clinical trial program. METHODS Discrimination of GAP was assessed by comparing placebo to active treatment arms. The magnitude of treatment effect and responsiveness were compared to Disease Activity Index for PsA (DAPSA), clinical DAPSA, DAPSA28, and Psoriatic Arthritis Disease Activity Score (PASDAS) using effect size (ES) and standardized response mean (SRM), respectively. Construct validity was evaluated through correlation among the composite endpoints, and with other physician- and patient-reported outcomes. Change in GAP was compared in patients who reached low disease activity (LDA) levels based on DAPSA, cDAPSA, and PASDAS vs those who did not. RESULTS GAP discriminated between active treatment and placebo with statistically significant separation as early as week 1. The largest ES/SRM was seen with GAP (2.29/1.74) and PASDAS (2.47/1.68). GAP had the strongest correlation with PASDAS (0.81-0.92) and showed moderate correlations with patient-assessed physical function, low correlations with physician-assessed skin and nail psoriasis, and low to moderate correlation with physician-assessed enthesitis. A significantly greater improvement in GAP was seen in the groups achieving LDA states compared to those not (p < 0.001). CONCLUSION The GAP composite, an abbreviated endpoint comprising measures common in electronic health records, has promising performance characteristics and could be used to address important clinical questions regarding outcomes and impact of PsA in existing datasets. CLINTRIALS. GOV IDENTIFIER NCT01695239; NCT02349295.
Collapse
Affiliation(s)
- William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Disease, Bath, UK
| | - Julie Birt
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA.
| | - Aisha Vadhariya
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Sarah Ross
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Marcus Ngantcha
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| | - Khai Jing Ng
- Lilly Corporate Center, Eli Lilly and Company, Indianapolis, IN, 46285, USA
| |
Collapse
|
2
|
Koc GH, Kok MR, do Rosario Y, Luime JJ, Tchetverikov I, Kasiem FR, Korswagen LA, Bijsterbosch J, Goekoop-Ruiterman YPM, van Oosterhout M, Baudoin P, Kok P, Dolhain RJEM, Vis M. Determinants of radiographic progression in early psoriatic arthritis: insights from a real-world cohort. RMD Open 2024; 10:e004080. [PMID: 38796181 PMCID: PMC11129034 DOI: 10.1136/rmdopen-2024-004080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 05/14/2024] [Indexed: 05/28/2024] Open
Abstract
OBJECTIVE Persistent articular inflammation in psoriatic arthritis (PsA) is associated with radiographic damage. Despite advances in diagnosis and therapy, radiographic structural damage remains prevalent in PsA. To elucidate this topic, we studied which baseline clinical characteristics determine radiographic progression. METHODS For this analysis, data were used from DEPAR (Dutch South West Psoriatic Arthritis) Study, a real-world cohort of patients with newly diagnosed PsA. Radiographic changes were assessed using the modified Total Sharp/van der Heijde Score (mTSS) for PsA. Univariable-multivariable mixed-effects negative binomial regression analysis was applied to define baseline predictors for radiographic progression over time. RESULTS The study included 476 patients with early PsA with 1660 hand and feet radiographs from four different time points (baseline, first, second and third year). The progressive group (n=71) had a higher mTSS compared with the non-progressive group (n=405) at diagnosis (17 (3-36) vs 0 (0-1)). A comparison of the two groups revealed that the progressive group had significantly older (59 (12) vs 49 (13)) and a higher rate of the presence of swollen joints (93% vs 78%) at diagnosis. Multivariable analysis identified age (incidence rate ratio (IRR)=1.10, p=0.000), sex (female) (IRR=0.48, p=0.043) and baseline mTSS (IRR=1.11, p=0.000) as significant determinants of radiographic change over time. For the progressive subset, additionally, the multivariable analysis highlighted baseline Disease Activity in PSoriatic Arthritis (IRR=1.05, p=0.006) and swollen joint count (IRR=1.07, p=0.034) as predictors. CONCLUSIONS According to this real-world cohort, patients with early PsA exhibit minimal radiographic progression under current treatment protocols. This study indicates that while old age and initial radiographic damage predict progression, female sex confers a protective effect on it. Furthermore, disease activity score and swollen joints emerged as predictors for radiographic changes during the follow-up in progressive patients.
Collapse
Affiliation(s)
- Gonul Hazal Koc
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marc R Kok
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Yvandra do Rosario
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands
| | - Fazira R Kasiem
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lindy-Anne Korswagen
- Department of Rheumatology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | | | | | | | - Paul Baudoin
- Department of Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | - Petra Kok
- Department of Rheumatology, Reinier de Graaf Gasthuis, Delft, The Netherlands
| | | | - Marijn Vis
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Ziadé N, Abbas N, Hmamouchi I, El Kibbi L, Maroof A, Elzorkany B, Abdulateef N, Adnan A, Ihsan Awadh N, Gorial FI, Alchama N, Haouichat C, Alnaimat F, Hannawi S, Atawnah S, Halabi H, Al Mashaleh M, Aljazwi L, Abogamal A, Ayoub L, Bouajina E, Bahiri R, Saad S, Sabkar M, Aouad K, Gossec L. Is the patient-perceived impact of psoriatic arthritis a global concept? An international study in 13 Arab countries (TACTIC study). Rheumatol Int 2024; 44:885-899. [PMID: 38498150 DOI: 10.1007/s00296-024-05552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/27/2024] [Indexed: 03/20/2024]
Abstract
The Psoriatic Arthritis Impact of Disease (PsAID-12) questionnaire, a recommended measure of patient-reported impact for psoriatic arthritis (PsA), was initially developed in Europe and may lack universal validity. Recognizing the need for a culturally appropriate tool for Arab patients, this study aimed to TranslAte, CulTurally adapt, and validate the PsAID in ArabIC (TACTIC). The PsAID-12 was translated into Arabic using a rigorous process of double translation, back-translation, and cognitive debriefing. The Arabic version was then validated through a study conducted in 13 Arab countries in 2022. Participants were consecutive literate adult patients diagnosed with PsA and fulfilling the CASPAR criteria. Collected data included PsAID-12, disease activity, and legacy patient-reported outcomes. Psychometric properties, such as internal consistency, construct validity, and test-retest reliability, were examined. Factors associated with high PsAID-12 total scores (> 4) were explored using multivariable binary logistic regression. A culturally adapted Arabic PsAID-12 questionnaire was achieved with minor rephrasing. The validation study included 554 patients from 13 countries (mean age 45 years, 59% females), with a mean PsAID score of 3.86 (SD 2.33). The Arabic PsAID-12 demonstrated excellent internal consistency (Cronbach's α = 0.95), and correlations with other measures ranged from 0.63 to 0.78. Test-retest reliability (N = 138 patients) was substantial (intraclass correlation coefficient, ICC 0.90 [0.86-0.93]; Cohen's kappa 0.80). Factors associated with a high PsAID score were disability (odds ratio, OR 3.15 [2.03-4.89]), depression (OR 1.56 [1.35-1.81]), widespread pain (OR 1.31 [1.12-1.53]), and disease activity (OR 1.29 [1.13-1.47]). Pain and fatigue were identified as the most impactful PsAID-12 domains for PsA patients. The Arabic PsAID is a valid and reliable measure that reflects the priorities of patients with PsA. PsAID scores correlated with disease activity and legacy outcome measures, as expected, indicating PsAID is a consistent measure of PsA impact across cultures. These findings highlight the potential of the Arabic PsAID in improving the care provided to Arabic-speaking patients worldwide.
Collapse
Affiliation(s)
- Nelly Ziadé
- Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon.
| | - Noura Abbas
- Saint-Joseph University, Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Ihsane Hmamouchi
- Laboratory of Clinical Research and Epidemiology, Faculty of Medicine, Mohammed V University, Rabat, Morocco
- Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
| | - Lina El Kibbi
- Division of Rheumatology, Department of Internal Medicine, Specialized Medical Centre, Riyadh, Saudi Arabia
| | - Avin Maroof
- University of Kurdistan-Hewler (UKH) School of Medicine; and Rizgary Hospital Erbil, Erbil, Iraq
| | | | - Nizar Abdulateef
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Asal Adnan
- Baghdad Teaching Hospital, Baghdad Medical City, Baghdad, Iraq
| | | | - Faiq Isho Gorial
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Nada Alchama
- Rheumatology Department, Ibn Al-Nafees Hospital, Damascus, Syria
| | - Chafika Haouichat
- Rheumatology Department, Djilali Bounaama University Hospital, Khemis Miliana, Douera, Algiers, Algeria
- Faculty of Medicine El Mahdi Si Ahmed., Blida, Algeria
| | - Fatima Alnaimat
- Division of Rheumatology, Department of Medicine, The University of Jordan, Amman, Jordan
| | - Suad Hannawi
- Rheumatology Department, Emirates Health Services, Ministry of Health and Prevention, Dubai, UAE
| | - Saed Atawnah
- Al-Ahli Hospital, Al-Quds University, Hebron, Palestine
| | - Hussein Halabi
- Section of Rheumatology, Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Manal Al Mashaleh
- Rheumatology Division of Internal Medicine, King Hussein Medical Centre, Royal Medical Services, Jordan Armed Forces, Amman, Jordan
| | | | - Ahmed Abogamal
- Al-Azhar Faculty of Medicine, Dr Sulaiman Al Habib Hospital, Dubai, UAE
| | - Laila Ayoub
- Rheumatology Unit, Department of Internal Medicine, Tripoli Central Hospital, Tripoli, Libya
- Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | | | - Rachid Bahiri
- El Ayachi Hospital, Medical University Hospital, Rabat, Morocco
| | - Sahar Saad
- Assiut Medical School of Egypt, King Hamad University Hospital Bahrain, Al Sayh, Bahrain
| | - Maha Sabkar
- King Hamad University Hospital, Al Sayh, Bahrain
| | - Krystel Aouad
- Saint George Hospital University Medical Centre, Saint George University of Beirut, Beirut, Lebanon
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| |
Collapse
|
4
|
Ak T, Mustafayeva L, Ayla AY, Celik Y, Can G, Ugurlu S. Secukinumab after first-line tumor necrosis factor-alpha inhibitor therapy in psoriatic arthritis: A real-world retrospective cohort study. Arch Rheumatol 2024; 39:71-80. [PMID: 38774692 PMCID: PMC11104763 DOI: 10.46497/archrheumatol.2024.10050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/30/2023] [Indexed: 05/24/2024] Open
Abstract
Objectives This study compared the secukinumab treatment responses and adverse effects in psoriatic arthritis patients who received secukinumab as second-line with those that received secukinumab after two or more tumor necrosis factor-alpha (TNF-α) inhibitors. Patients and methods The retrospective study included 68 psoriatic arthritis patients followed up between October 2018 and October 2021. The patients were divided into two groups according to their anti-TNF-α treatment history. Group 1 consisted of 29 patients (11 males, 18 females; mean age: 45.3±13.3 years; range, 21 to 69 years) who had previously received one anti-TNF-α agent, while Group 2 included 39 patients (18 males, 21 females; mean age: 46.4±13.0 years; range, 24 to 70 years) who had been treated with two or more anti-TNF-α agents. Treatment responses of the groups were measured and compared using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Visual Analog Scale (VAS). A posttreatment BASDAI score ≤4 was used as a criterion for remission. Results The mean duration of secukinumab treatment was 16.6±12.7 months for Group 1 and 16.0±11.6 months for Group 2 (p=0.84). Both groups responded significantly to secukinumab in terms of BASDAI and VAS scores (p<0.001 and p<0.001, respectively). Group 1 had a greater decline in BASDAI and VAS scores than Group 2 (p=0.045 and p=0.032, respectively). Furthermore, the remission rate was greater in Group 1 compared to Group 2 (58% vs. 34%, p=0.03). The adverse effects of secukinumab treatment were an allergic reaction in Group 1 and one case of ulcerative colitis in Group 2. Conclusion Second-line secukinumab treatment resulted in a greater decline in BASDAI and VAS scores. Moreover, secukinumab achieved a significantly higher rate of remission when it was used as second-line therapy after one anti-TNF-α agent.
Collapse
Affiliation(s)
- Tumay Ak
- Department of Internal Medicine, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
| | - Leyla Mustafayeva
- Department of Physical Therapy and Rehabilitation, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
| | - Ali Yagiz Ayla
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
| | - Yeliz Celik
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
| | - Gunay Can
- Department of Public Health, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
| | - Serdal Ugurlu
- Department of Internal Medicine, Division of Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical Faculty, Istanbul, Türkiye
| |
Collapse
|
5
|
Snoeck Henkemans SVJ, de Jong PHP, Luime JJ, Kok MR, Tchetverikov I, Korswagen LA, van der Kooij SM, van Oosterhout M, Baudoin P, Bijsterbosch J, van der Kaap JH, van der Helm-van Mil AHM, Vis M. Window of opportunity in psoriatic arthritis: the earlier the better? RMD Open 2024; 10:e004062. [PMID: 38413172 PMCID: PMC10900390 DOI: 10.1136/rmdopen-2023-004062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/10/2024] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES To investigate whether there is a window of opportunity for psoriatic arthritis (PsA) patients and to assess which patient characteristics are associated with a longer diagnostic delay. METHODS All newly diagnosed, disease-modifying antirheumatic drug-naïve PsA patients who participated in the Dutch southwest Early PsA cohoRt and had ≥3 years of follow-up were studied. First, total delay was calculated as the time period between symptom onset and PsA diagnosis made by a rheumatologist and then split into patient and physician delays. The total delay was categorised into short (<12 weeks), intermediate (12 weeks to 1 year) or long (>1 year). These groups were compared on clinical (Minimal Disease Activity (MDA) and Disease Activity index for PSoriatic Arthritis (DAPSA) remission) and patient-reported outcomes during 3 years follow-up. RESULTS 708 PsA patients were studied of whom 136 (19%), 237 (33%) and 335 (47%) had a short, intermediate and long total delay, respectively. Patient delay was 1.0 month and physician delay was 4.5 months. Patients with a short delay were more likely to achieve MDA (OR 2.55, p=0.003) and DAPSA remission (OR 2.35,p=0.004) compared with PsA patients with a long delay. Patient-reported outcomes showed numerical but non-significant differences between the short and long delay groups. Female patients and those presenting with enthesitis, chronic back pain or normal C-reactive protein (CRP) had a longer delay. CONCLUSIONS In PsA, referral and diagnosis within 1 year is associated with better clinical outcomes, suggesting the presence of a window of opportunity. The most gain in referral could be obtained in physician delay and in females, patients with enthesitis, chronic back pain or normal CRP.
Collapse
Affiliation(s)
| | | | | | - Marc R Kok
- Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | | | - Paul Baudoin
- Rheumatology, Reumazorg Zuid West Nederland, Roosendaal, The Netherlands
| | | | | | | | - Marijn Vis
- Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
6
|
Lo Monaco M, Mallaci Bocchio R, Natoli G, Giardina A, Cangemi I, Scibetta S, Argano C, Corrao S. Critical importance of patient-reported outcomes for a comprehensive assessment of psoriatic arthritis patients. Front Med (Lausanne) 2024; 10:1332432. [PMID: 38293304 PMCID: PMC10826607 DOI: 10.3389/fmed.2023.1332432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/28/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Psoriatic arthritis (PsA) is a heterogeneous, chronic inflammatory disease that negatively impacts patients' quality of life. Patient-reported outcome measures (PROMs) are used to capture patient perspectives in disease assessment, and physicians use the Disease Activity Index for Psoriatic Arthritis (DAPSA) to evaluate disease activity in PsA. The study aimed to assess the relationship between PROMs and the DAPSA score in consecutive outpatients affected by PsA. Materials and methods A cross-sectional study was conducted from March 2018 to October 2020 at the PsA clinic of the ARNAS Civico in Palermo (Italy), enrolling outpatients with PsA. Patients were assessed for their disease activity according to the DAPSA score, and PROMs, such as PHQ-9, HAQ, FACIT-F, and PsAID, were evaluated. Linear regression analysis evaluated the relationship between the DAPSA Score and the included PROMs. Results 158 PsA consecutive peripheral subset psoriatic arthritis outpatients were recruited. The median years of illness was 10.6 (9.3-11.9), and the median DAPSA score was 19.02 (9-33.1). The regression analysis highlighted a strong relationship between the DAPSA score and the PsAID (adjR2 26%, p < 0.0001), the FACIT-F (adjR2 25.4%, p < 0.0001), the HAQ (adjR2 23.7%, p < 0.0001), and PHQ-9 (adjR2 15%, p < 0.0001). Conclusion PROMs are strongly associated with the DAPSA score, but it allows in-depth evaluation of the impact of the disease on different domains of PsA patients' life.
Collapse
Affiliation(s)
- Marika Lo Monaco
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Raffaella Mallaci Bocchio
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Giuseppe Natoli
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Annarita Giardina
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Ignazio Cangemi
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Scibetta
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Christiano Argano
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Salvatore Corrao
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy
- Department of Clinical Medicine, Internal Medicine Unit with Rheumatology, Dermatology, Diabetology and Tertiary Diabetic Foot Healthcare, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| |
Collapse
|
7
|
Yu N, Peng C, Zhou J, Gu J, Xu J, Li X, Bi X, Deng H, Li X, Ding Y, Shi Y. Measurement properties of the patient global assessment numerical rating scale in moderate-to-severe psoriasis. Br J Dermatol 2023; 189:437-446. [PMID: 37310289 DOI: 10.1093/bjd/ljad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 05/03/2023] [Accepted: 06/02/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Patient global assessment (PtGA) has been recommended as one of the core domains in psoriasis clinical trials. Among multiple versions of PtGA, the single-question, 11-point PtGA numeric rating scale (NRS) remains to be validated in patients with plaque psoriasis. OBJECTIVES To evaluate the psychometric characteristics of an 11-point PtGA NRS for disease severity in patients with moderate-to-severe plaque psoriasis. METHODS Data were analysed from 759 patients with moderate-to-severe psoriasis in the Shanghai Psoriasis Effectiveness Evaluation CoHort (SPEECH), a prospective, multicentre and observational registry assessing the comparative effectiveness and safety of biologics (adalimumab, ustekinumab, secukinumab or ixekizumab), conventional systemic therapies (acitretin or methotrexate) and phototherapy. RESULTS The test-retest reliability of the PtGA NRS showed good agreement (intraclass correlation coefficient range 0.79-0.83). No floor or ceiling effects of PtGA NRS were observed. The PtGA NRS was significantly correlated with the Psoriasis Area and Severity Index (PASI), static Physician Global Assessment (sPGA), body surface area, Dermatology Quality of Life Index (DLQI) and Hospital Anxiety and Depression Scale. Relatively large correlations of PtGA NRS with PASI and the DLQI 'symptoms and feelings' domain (all correlations ≥ 0.4 except at baseline) supported convergent validity. The presence of psoriatic arthritis or joint symptoms had no significant association with the PtGA NRS. In multivariate regression analyses, the PtGA NRS at baseline was predicted by age, lesion extent, lesion intensity, patients' symptoms and feelings, and impact on work or school. The PtGA NRS displayed known-groups validity with the PASI, sPGA and DLQI score bands. The PtGA NRS was responsive to change in PASI and DLQI after treatment. Anchor- and distribution-based approaches supported -3 as the minimal important difference for PtGA NRS. An absolute PtGA NRS ≤ 2 during follow-up was concordant with the state of minimal disease activity based on a 90% reduction in PASI (PASI 90) or PASI 90 plus a DLQI of 0/1. Sensitivity analysis using subgroup comparison and multiple imputation model yielded consistent conclusions. CONCLUSIONS The PtGA NRS showed good reliability, validity and responsiveness in patients with psoriasis, and was feasible in clinical trials and daily practice.
Collapse
Affiliation(s)
- Ning Yu
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis
| | - Chen Peng
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis
| | - Jing Zhou
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis
| | - Jun Gu
- Department of Dermatology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xia Li
- Department of Dermatology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinling Bi
- Department of Dermatology, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Hui Deng
- Department of Dermatology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xin Li
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yangfeng Ding
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis
| | - Yuling Shi
- Department of Dermatology, Shanghai Skin Disease Hospital, Institute of Psoriasis
| |
Collapse
|
8
|
Loo YP, Loo CH, Lim AL, Wong CK, Ali NBM, Khor YH, Tan WC. Prevalence and risk factors associated with psoriatic arthritis among patients with psoriasis. Int J Rheum Dis 2023; 26:1788-1798. [PMID: 37485806 DOI: 10.1111/1756-185x.14833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 04/14/2023] [Accepted: 06/28/2023] [Indexed: 07/25/2023]
Abstract
INTRODUCTION Psoriatic arthritis is a chronic, autoimmune inflammatory arthritis that occurs with psoriasis and has profound impact on patients' physical and psychological well-being. This study aims to determine the prevalence and risk factors associated with psoriatic arthritis among patients with psoriasis. METHODS A single-center, cross-sectional study was conducted over a 12-month period at the Dermatology Clinic, Hospital Pulau Pinang, Malaysia involving all consecutive psoriasis patients. CASPAR (ClASsification of Psoriatic ARthritis) criteria were used to diagnose psoriatic arthritis. RESULTS A total of 360 patients with psoriasis were recruited, of whom 107 (29.7%) had psoriatic arthritis. Psoriatic arthritis patients had equal gender distribution and the mean age of arthritis onset was 40.7 ± 12.8 years. Psoriasis preceded arthritis in 81.3% of patients (n = 87) with a mean latency interval of 10.5 years. Polyarthropathy was the predominant subtype affecting 46.8% (n = 50) of patients, followed by oligoarthropathy (22.4%, n = 24), axial joint disease (5.6%, n = 6), predominant distal interphalangeal joint disease (2.8%, n = 3), and mixed subtype (22.4%, n = 24). Enthesitis and dactylitis occurred in 12.1% (n = 13) and 20.6% (n = 22) of arthritis patients, respectively, and deformity was present in 37.4% (n = 40). Psoriatic arthritis was significantly associated with being an ever smoker (adjusted odds ratio [aOR] 0.41; 95% confidence interval [CI] 0.18-0.91, p = .029), genital psoriasis (aOR 2.25; 95% CI 1.17-4.33, p = .015), and increased erythrocyte sedimentation rate (ESR) (aOR 1.02; 95% CI 1.01-1.04, p = .005) and C-reactive protein [CRP] (aOR 1.04; 95% CI 1.00-1.08, p = .040). CONCLUSION Our study showed a high prevalence of psoriatic arthritis among the psoriasis cohort. Genital involvement, and increased ESR and CRP were associated with psoriatic arthritis among patients with psoriasis.
Collapse
Affiliation(s)
- Yin Pin Loo
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia
- Department of Medicine, Hospital Canselor Tuanku Muhriz UKM, Kuala Lumpur, Malaysia
| | - Chai Har Loo
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia
| | - Ai Lee Lim
- Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
| | - Chee Keong Wong
- Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia
| | | | - Yek Huan Khor
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia
| | - Wooi Chiang Tan
- Department of Dermatology, Hospital Pulau Pinang, Penang, Malaysia
| |
Collapse
|
9
|
Tillett W, Birt J, Cavanaugh C, Jung Y, Vadhariya A, Ross S, Paulus J, Lubrano E. Changes in musculoskeletal disease activity and patient-reported outcomes in patients with psoriatic arthritis treated with ixekizumab: results from a real-world US cohort. Front Med (Lausanne) 2023; 10:1184028. [PMID: 37415769 PMCID: PMC10322216 DOI: 10.3389/fmed.2023.1184028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 05/30/2023] [Indexed: 07/08/2023] Open
Abstract
Introduction Ixekizumab has demonstrated efficacy in pivotal trials in patients with psoriatic arthritis (PsA), both those naïve to prior biologic therapy and those with prior inadequate response or intolerance to biologics; however, minimal information is currently available on the effectiveness of ixekizumab in routine clinical practice. The objective of this study was to investigate the clinical effectiveness of ixekizumab for the treatment of PsA over 6- and 12-month follow-up periods in a real-world setting. Methods This retrospective cohort study included patients who initiated treatment with ixekizumab from the OM1 PremiOMTM PsA dataset, a dataset of over 50,000 patients with claims and electronic medical record (EMR) data. Changes in musculoskeletal outcomes, such as tender and swollen joint count and patient-reported pain, as well as physician and patient global assessment, as measured using the Clinical Disease Activity Index (CDAI), and Routine Assessment of Patient Index Data 3 (RAPID3) were summarized at 6 and 12 months. The RAPID3, CDAI score, and their individual components were assessed in multivariable regressions adjusting for age, sex, and baseline value. The results were stratified by biologic disease-modifying antirheumatic drug (bDMARD) status (naïve vs. experienced) and monotherapy status (monotherapy vs. combination therapy with conventional synthetic DMARDs). Changes in a 3-item composite score derived from a physician global assessment, patient global assessment, and patient-reported pain score were summarized. Results Among the 1,812 patients identified receiving ixekizumab, 84% had prior bDMARD treatment and 82% were monotherapy users. All outcomes improved at 6 and 12 months. For RAPID3, the mean (SD) change at 6 and 12 months was -1.2 (5.5) and -1.2 (5.9), respectively. Patients overall, bDMARD experienced, and monotherapy patients achieved statistically significant mean change in CDAI and all components from baseline to 6 and 12 months in adjusted analyses. Patients experienced an improvement in the 3-item composite score at both time points. Conclusion Treatment with ixekizumab was associated with improvements in musculoskeletal disease activity and PROs as assessed by several outcome measures. Future research should assess ixekizumab's clinical effectiveness in the real world across all PsA domains using PsA-specific endpoints.
Collapse
Affiliation(s)
- William Tillett
- Department of Rheumatology, Royal National Hospital for Rheumatic Disease, Bath, United Kingdom
| | - Julie Birt
- Eli Lilly and Company, Indianapolis, IN, United States
| | | | | | | | - Sarah Ross
- Eli Lilly and Company, Indianapolis, IN, United States
| | | | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento Di Medicina e Scienze, Della Salute “Vincenzo Tiberio”, Università Degli Studi del Molise, Campobasso, Italy
| |
Collapse
|
10
|
Lubrano E, Scriffignano S, Fatica M, Triggianese P, Conigliaro P, Perrotta FM, Chimenti MS. Psoriatic Arthritis in Males and Females: Differences and Similarities. Rheumatol Ther 2023; 10:589-599. [PMID: 36795290 PMCID: PMC10140210 DOI: 10.1007/s40744-023-00535-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 01/25/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To assess any differences and similarities in psoriatic arthritis (PsA) between sexes. Any possible differences of psoriasis and its potential impact on disease burden between sexes with PsA were also evaluated. METHODS Cross-sectional analysis of two longitudinal PsA cohorts. The impact of psoriasis on the PtGA was evaluated. Patients were stratified in four groups based on BSA. The median PtGA was then compared between the four groups. Moreover, a multivariate linear regression analysis was performed in order to evaluate associations between PtGA and skin involvement, split by sexes. RESULTS We enrolled 141 males and 131 females: PtGA, PtPnV, tender, swollen joint count, DAPSA, HAQ-DI, PsAID-12 were statistically significant higher in females (p ≤ 0.05). PASS "yes" was deemed more in males than in females and BSA was higher in males. MDA was present more in males than females. When the patients were stratified on BSA, median PtGA was not different between males and females with BSA = 0. Instead, in females with BSA > 0, a higher PtGA was observed compared to males with BSA > 0. There was not a statistically significant association between skin involvement and PtGA at linear regression analysis, even if a trend seems to be present in female. CONCLUSIONS Psoriasis is more present in males, but it seems to be related to a worse impact in females. In particular, a possible role of psoriasis as an influencing factor the PtGA was found. Moreover, female PsA patients tended to have more disease activity, worse function, and higher disease burden.
Collapse
Affiliation(s)
- Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy.
| | - Silvia Scriffignano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
| | - Mauro Fatica
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Triggianese
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Paola Conigliaro
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabio Massimo Perrotta
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Via Giovanni Paolo II, C/da Tappino, 86100, Campobasso, Italy
| | - Maria Sole Chimenti
- Rheumatology, Allergology and Clinical Immunology, Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
11
|
Mease PJ, Asahina A, Gladman DD, Tanaka Y, Tillett W, Ink B, Assudani D, de la Loge C, Coarse J, Eells J, Gossec L. Effect of bimekizumab on symptoms and impact of disease in patients with psoriatic arthritis over 3 years: results from BE ACTIVE. Rheumatology (Oxford) 2023; 62:617-628. [PMID: 35789257 PMCID: PMC9891423 DOI: 10.1093/rheumatology/keac353] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Evaluate effects of long-term bimekizumab treatment on patient-reported outcome (PRO) measures, symptoms and the impact of PsA on patients. METHODS Patients with active PsA were enrolled into BE ACTIVE, a 48-week randomised controlled trial (NCT02969525). After Week 48, patients could enter a 104-week open-label extension (NCT03347110), receiving bimekizumab 160 mg every four weeks. PRO measures assessed included arthritis pain visual analogue scale (VAS), PsA Impact of Disease (PsAID)-9, 36-Item Short Form Survey (SF-36) and HAQ-Disability Index (HAQ-DI). Results were analysed as mean (S.E.M.) changes from baseline (CfB) from Week 0 to the end of the open-label extension (3 years) and as percentage of patients reaching patient-acceptable symptom state (PASS) for global impact (PsAID-9 total score ≤4) and normal function (HAQ-DI total score <0.5). Non-responder imputation was applied to missing binary outcomes. RESULTS In 206 patients (mean age 49.3 years, 51.0% male), completion rate was high; 161 (78.2%) patients completed Week 152. Bimekizumab treatment was associated with long-term sustained improvements in pain [arthritis pain VAS CfB; Week 48: -29.9 (1.9); Week 152: -32.0 (1.9)] and fatigue [PsAID-9 fatigue CfB; -2.4 (0.2); -2.7 (0.2)]. High percentages of patients achieved acceptable symptom state (PsAID-9 PASS: 75.2%; 65.0%) and normalised function (HAQ-DI <0.5: 49.0%; 46.1%). Improvements in patient global assessment and SF-36 Physical Component Summary were also sustained. CONCLUSIONS Bimekizumab treatment was associated with long-term sustained improvements in pain and fatigue, reducing overall impact of PsA on patients. Physical function and quality of life improved up to 3 years. TRIAL REGISTRATION ClinicalTrials.gov, https://clinicaltrials.gov, NCT02969525, NCT03347110.
Collapse
Affiliation(s)
- Philip J Mease
- Swedish Medical Center/Providence St. Joseph Health and University of Washington, Seattle, WA, USA
| | - Akihiko Asahina
- Department of Dermatology, The Jikei University School of Medicine, Tokyo, Japan
| | - Dafna D Gladman
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - William Tillett
- Department of Pharmacy and Pharmacology, University of Bath, Bath
| | | | | | | | | | | | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique.,Rheumatology Department, Pitié-Salpêtrière Hospital, AP-HP.Sorbonne Université, Paris, France
| |
Collapse
|
12
|
Snoeck Henkemans SVJ, de Jong PHP, Luime JJ, Kok MR, Tchetverikov I, Kasiem FR, Welby S, Prickett AR, van der Helm-van Mil AHM, Vis M. Importance of quick attainment of minimal disease activity for a positive impact on lives of patients with psoriatic arthritis. RMD Open 2022; 8:rmdopen-2022-002706. [PMID: 36597984 PMCID: PMC9730421 DOI: 10.1136/rmdopen-2022-002706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To compare patient-reported outcomes (PROs) from the first year to the third year between patients with psoriatic arthritis (PsA) who achieved minimal disease activity (MDA) in the first year after diagnosis and those who did not. METHODS Consecutive, newly diagnosed, patients with DMARD naïve PsA with oligoarthritis or polyarthritis were selected from the Dutch southwest Early PsA cohoRt. Patients were categorised in three groups: (1) Patients who were in MDA at both 9 months and 12 months after diagnosis (sustained MDA); (2) Patients who achieved MDA in the first year but in whom it was not sustained at both 9 months and 12 months (non-sustained MDA); (3) Patients who did not achieve MDA in the first year (no MDA). PROs were compared between groups from the first year to the third year after diagnosis using a linear mixed model. RESULTS 240 patients were selected; 104 (43%) were classified as sustained MDA, 60 (25%) as non-sustained MDA and 76 (32%) as no MDA. Patients who did not achieve MDA in the first year experienced remarkably lower PROs during follow-up, compared with the sustained MDA group: health status (European Quality of life 5-Dimensions 5-Levels) was 0.23 units lower (95% CI -0.28 to -0.18), functional impairment (Health Assessment Questionnaire-Disability Index) was 0.81 units higher (95% CI 0.70 to 0.92), pain (Visual Analogue Scale) was 35.38 mm higher (95% CI 30.57 to 40.18), fatigue (Bristol Rheumatoid Arthritis Fatigue-Multidimensional Questionnaire) was 17.88 units higher (95% CI 14.60 to 21.16), and anxiety and depression (Hospital Anxiety and Depression Scale) were, respectively, 3.26 units (95% CI 2.25 to 4.27) and 4.04 units higher (95% CI 3.10 to 4.99). CONCLUSION Failure to achieve MDA in the first year after PsA diagnosis was associated with worse PROs that persisted over the years.
Collapse
Affiliation(s)
| | | | | | - Marc R Kok
- Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | | | | | | | | | - Marijn Vis
- Rheumatology, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
13
|
Ross L, Nikpour M, D'Aoust J, Khanna D, Merkel PA, Pauling JD, Baron M. Patient and Physician Global Assessments of Disease Status in Systemic Sclerosis. Arthritis Care Res (Hoboken) 2022. [PMID: 36342397 DOI: 10.1002/acr.25056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/11/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022]
Abstract
Global assessments of disease by both patients and physicians are widely used in clinical studies of systemic sclerosis (SSc). They are commonly secondary end points in randomized controlled trials (RCTs) and are considered important items in composite measures of treatment response. A comprehensive literature review was conducted of the formats, wording, and clinimetric properties of the patient global assessment of disease status (PtGA) and physician global assessment of disease status (PhGA) used in RCTs of SSc. Marked heterogeneity was found in the wording and measurement scales of the global assessments applied in RCTs. These instruments were not developed using rigorous methodology and have not been fully validated. There is a pressing need for standardization and validation of patient and physician global assessment tools in SSc to enable universal application of these measures across RCTs in SSc.
Collapse
Affiliation(s)
- Laura Ross
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Mandana Nikpour
- The University of Melbourne at St Vincent's Hospital and St Vincent's Hospital, Melbourne, Victoria, Australia
| | - Julie D'Aoust
- The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | - Murray Baron
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
14
|
Clinical Characteristics of Registry Participants with Psoriatic Arthritis Initiating Guselkumab: An Analysis from the CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry. Drugs Real World Outcomes 2022; 9:617-628. [PMID: 36243860 DOI: 10.1007/s40801-022-00326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The monoclonal antibody guselkumab is the first selective inhibitor of the interleukin-23 p19 subunit approved to treat adults with moderate-to-severe plaque psoriasis and active psoriatic arthritis (PsA). Given its recent approval for active PsA, data describing patients with PsA initiating guselkumab outside of clinical trials are limited. OBJECTIVE This analysis describes characteristics of patients with rheumatologist-diagnosed PsA initiating guselkumab in the US-based, prospective, observational CorEvitas Psoriatic Arthritis/Spondyloarthritis Registry. METHODS Demographics, lifestyle/disease characteristics, comorbidities, prior treatment, and disease activity were summarized for patients with PsA initiating guselkumab from registry inception through 30 September, 2021. RESULTS Of 113 patients initiating guselkumab, the majority were female (63%), obese (67%), had psoriasis (89%), and initiated guselkumab as monotherapy (81%). Common comorbidities were hypertension (32%), depression (30%), and diabetes mellitus (26%). Mean tender (6.8) and swollen (2.0) joint counts, clinical Disease Activity Index for PsA score (19.1), and 57% of participants with ≥ 3% body surface area affected by psoriasis indicated moderate disease activity. Axial involvement was identified in 49% of patients. Median patient-reported pain and fatigue visual analog scale scores (0-100) were 60 and 59, respectively. Prior to guselkumab, 76% of patients had received two or more biologic disease-modifying antirheumatic drugs; the last therapy prior to guselkumab was a biologic disease-modifying antirheumatic drug in 81% of patients. CONCLUSIONS Registry participants with PsA initiating guselkumab had active peripheral joint and skin disease, with substantial pain and fatigue; a considerable proportion had axial involvement. Future studies will evaluate the effectiveness of guselkumab in this population.
Collapse
|
15
|
Lucasson F, Kiltz U, Kalyoncu U, Leung YY, Palominos P, Cañete JD, Scrivo R, Balanescu A, Dernis E, Meisalu S, Ryussen-Witrand A, Soubrier M, Aydin SZ, Eder L, Gaydukova I, Lubrano E, Richette P, Husni E, Coates LC, de Wit M, Smolen JS, Orbai AM, Gossec L. Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries. RMD Open 2022; 8:e002031. [PMID: 35523519 PMCID: PMC9083399 DOI: 10.1136/rmdopen-2021-002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 04/14/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Patient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments. METHODS A cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA >14) and no ongoing bDMARD prescription. RESULTS In 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity and disease impact were higher in the lowest GDP/capita countries. DAPSA remission and MDA were attained in the lowest tertile in 7.0% and 18.4% patients, vs 29.1% and 49.5% in the middle tertile and 16.8% and 41.3% in the high tertile, respectively (all p<0.001). bDMARDs use was similar in the tertiles (overall mean 61%). The overall rate of patients with DAPSA >14 and no bDMARDs was 18.5%, and was higher in lower GDP/capita countries (p=0.004). CONCLUSION PsA patients from countries with the lowest GDP/capita, despite similar use of bDMARDs, were more likely to have high disease activity and worse disease impact. There is a need for more equity in healthcare.
Collapse
Affiliation(s)
- Florian Lucasson
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
| | - Uta Kiltz
- Herne and Ruhr-Universität, Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Umut Kalyoncu
- Department of Internal Medicine, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ying Ying Leung
- Duke-NUS Medical School, Singapore General Hospital, Singapore
| | - Penélope Palominos
- Rheumatology Department, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Juan D Cañete
- Servicio de Reumatología, Hospital Clínic and IDIBAPS, Barcelona, Spain
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza Università di Roma, Roma, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, "Sf. Maria" Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | | | - Adeline Ryussen-Witrand
- Centre d'Investigation Clinique de Toulouse CIC1436, Inserm, Paul Sabatier University, Toulouse University Hospital, Toulouse, France
| | | | - Sibel Zehra Aydin
- The Ottawa Hospital Research Institute, University of Ottawa Faculty of Medicine, Ottawa, Ontario, Canada
| | - Lihi Eder
- Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Inna Gaydukova
- North-western State Medical University, St.Petersburg, Russian Federation
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Pascal Richette
- Service de Rhumatologie, Hopital Lariboisiere Centre Viggo Petersen, Paris, France
- Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France
| | - Elaine Husni
- Department of Rheumatic and Immunologic Diseases, Cleveland Clinic, Cleveland, Ohio, USA
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Maarten de Wit
- Patient Research Partner, EULAR, Zaltbommel, The Netherlands
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Wien, Austria
| | - Ana-Maria Orbai
- Division of Rheumatology, Psoriatic Arthritis Program, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Universite, Paris, France
- APHP, Rheumatology Department, Hopital Universitaire Pitie Salpetriere, Paris, France
| |
Collapse
|
16
|
Taylor PC, Bushmakin AG, Cappelleri JC, Young P, Germino R, Merola JF, Yosipovitch G. Relationships of dermatologic symptoms and quality of life in patients with psoriatic arthritis: analysis of two tofacitinib phase III studies. J DERMATOL TREAT 2022; 33:2614-2620. [PMID: 35385361 DOI: 10.1080/09546634.2022.2060924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objectives Evaluate relationships between changes in dermatologic assessments and quality of life (QoL) measures; quantify dermatologic symptom severity impacts on QoL in patients with psoriatic arthritis (PsA) treated with tofacitinib.Methods Data were from two phase III studies; patients received tofacitinib 5 or 10 mg twice daily (BID), adalimumab 40 mg every other week, or placebo advancing to tofacitinib 5 or 10 mg BID at Month 3. Repeated measures longitudinal models assessed relationships between dermatologic assessments (predictors) Itch Severity Item (ISI), Physician's Global Assessment of Psoriasis (PGA-PsO), and Patient's Global Joint and Skin Assessment-Visual Analog Scale-Psoriasis question (PGJS-VAS-PsO), and QoL measures (outcomes) Dermatology Life Quality Index (DLQI) and Short Form-36 Health Survey Version 2 (SF-36v2). Models included one predictor and one outcome.Results Direct, approximately linear relationships existed between predictors and outcomes. ISI/PGA-PsO/PGJS-VAS-PsO improvements from baseline of ≥3/≥2/≥40-mm VAS corresponded with clinically meaningful DLQI improvements; improvements from baseline of ≥4/≥3/≥40-mm VAS generally corresponded with clinically meaningful improvements across component scores and all SF-36v2 domains.Conclusion Substantial links exist between dermatologic symptoms and QoL in patients with PsA, potentially informing patient-centered care and research. Rheumatologists should be aware of dermatologic manifestations and QoL impacts in patients with PsA.ClinicalTrials.gov NCT01877668; NCT01882439.
Collapse
Affiliation(s)
| | | | | | | | | | - Joseph F Merola
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | |
Collapse
|
17
|
Eriksen TE, Dinesen WKH, Uhrenholt L, Dreyer L, Duch K, Kristensen S. Isolation in patients with inflammatory rheumatic diseases during COVID-19 pandemic compared to healthy individuals: a questionnaire survey. Rheumatol Int 2022; 42:783-790. [PMID: 35359192 PMCID: PMC8970065 DOI: 10.1007/s00296-022-05111-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/07/2022] [Indexed: 10/31/2022]
Abstract
As a result of the pandemic, many patients with an inflammatory rheumatic disease (IRD) have isolated themselves. The lack of disease management together with fear of infection could lead to changes in physical- and mental health. The aim of this study was to evaluate the social- and health behaviour in patients with an IRD compared with the behaviour of healthy individuals during the COVID-19 pandemic. The study was a questionnaire survey answered by patients with an IRD and healthy individuals (HI). The questionnaire contained seven sections with questions regarding COVID-19 and quality of life including SF-36, EQ-5D-5L, and visual analogue scale (VAS) pain, fatigue and global health. Of 1663 invited participants, 661 patients with IRD and 266 HI were included in the analyses. Patients with an IRD felt more isolated during the COVID-19 pandemic compared with HI (IRD: 9.5% (61/644), HI: 3.1% (8/259), p-value = 0.001). More HI (5.4%) had been infected with COVID-19 than patients with an IRD (1.7%). Among patients with an IRD those with worse self-reported disease activity outcomes (VAS pain, fatigue and global health, all p-value < 0.001), worse social functioning and emotional well-being were more isolated than individuals with low disease activity. Patients with an IRD feel more isolated during the COVID-19 pandemic compared to HI. Isolation seems to be most pronounced in patients with worse disease related patient-reported outcomes and lower quality of life.
Collapse
Affiliation(s)
- Tobias Eschricht Eriksen
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Wilfred K H Dinesen
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Line Uhrenholt
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lene Dreyer
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirsten Duch
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark.,Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Salome Kristensen
- Department of Rheumatology, Aalborg University Hospital, Reberbansgade 15, 9000, Aalborg, Denmark. .,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| |
Collapse
|
18
|
Poddubnyy D, Baraliakos X, Van den Bosch F, Braun J, Coates LC, Chandran V, Diekhoff T, van Gaalen FA, Gensler LS, Goel N, Gottlieb AB, van der Heijde D, Helliwell PS, Hermann KGA, Jadon D, Lambert RG, Maksymowych WP, Mease P, Nash P, Proft F, Protopopov M, Sieper J, Torgutalp M, Gladman DD. Axial Involvement in Psoriatic Arthritis cohort (AXIS): the protocol of a joint project of the Assessment of SpondyloArthritis international Society (ASAS) and the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA). Ther Adv Musculoskelet Dis 2021; 13:1759720X211057975. [PMID: 34987619 PMCID: PMC8721378 DOI: 10.1177/1759720x211057975] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 10/14/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Involvement of the axial skeleton (sacroiliac joints and spine) is a relatively frequent manifestation associated with psoriatic skin disease, mostly along with involvement of peripheral musculoskeletal structures (peripheral arthritis, enthesitis, dactylitis), which are referred to as psoriatic arthritis (PsA). Data suggest that up to 30% of patients with psoriasis have PsA. Depending on the definition used, the prevalence of axial involvement varies from 25% to 70% of patients with PsA. However, there are currently no widely accepted criteria for axial involvement in PsA.Objective: The overarching aim of the Axial Involvement in Psoriatic Arthritis (AXIS) study is to systematically evaluate clinical and imaging manifestations indicative of axial involvement in patients with PsA and to develop classification criteria and a unified nomenclature for axial involvement in PsA that would allow defining a homogeneous subgroup of patients for research. DESIGN Prospective, multicenter, multinational, cross-sectional study. METHODS AND ANALYSES In this multicenter, multinational, cross-sectional study, eligible patients [adult patients diagnosed with PsA and fulfilling Classification Criteria for Psoriatic Arthritis (CASPAR) with musculoskeletal symptom duration of ⩽10 years not treated with biological or targeted synthetic disease-modifying anti-rheumatic drugs] will be recruited prospectively. They will undergo study-related clinical and imaging examinations. Imaging will include radiography and magnetic resonance imaging examinations of sacroiliac joints and spine. Local investigators will evaluate for the presence of axial involvement based on clinical and imaging information which will represent the primary outcome of the study. In addition, imaging will undergo evaluation by central review. Finally, the central clinical committee will determine the presence of axial involvement based on all available information. ETHICS The study will be performed according to the ethical principles of the Declaration of Helsinki and International Council for Harmonisation Good Clinical Practice guidelines. The study protocol will be approved by the individual Independent Ethics Committee / Institutional Review Board of participating centers. Written informed consent will be obtained from all included patients.Registration: ClinicalTrials.gov ID: NCT04434885.
Collapse
Affiliation(s)
- Denis Poddubnyy
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203 Berlin, Germany
| | | | - Filip Van den Bosch
- Department of Internal Medicine and Pediatrics, Ghent University, VIB Center for Inflammation Research, Ghent, Belgium
| | - Jürgen Braun
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, Bochum, Germany
| | - Laura C. Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Vinod Chandran
- Division of Rheumatology, Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| | - Torsten Diekhoff
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Floris A. van Gaalen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lianne S. Gensler
- Division of Rheumatology, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Niti Goel
- Patient Research Partner; Abcuro, Inc., Newton, MA, USA; Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alice B. Gottlieb
- Department of Dermatology, Mount Sinai-Beth Israel Hospital, Icahn School of Medicine, New York, NY, USA
| | | | - Philip S. Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | | | - Deepak Jadon
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Robert G. Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada; Medical Imaging Consultants, Edmonton, AB, Canada
| | - Walter P. Maksymowych
- Department of Medicine, University of Alberta, Edmonton, AB, Canada; CARE Arthritis, Edmonton, AB, Canada
| | - Philip Mease
- Division of Rheumatology Research, Swedish Medical Center/Providence St. Joseph Health and University of Washington School of Medicine, Seattle, WA, USA
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, QLD, Australia
| | - Fabian Proft
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Mikhail Protopopov
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim Sieper
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Murat Torgutalp
- Department of Gastroenterology, Infectious Diseases and Rheumatology (including Nutrition Medicine), Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Dafna D. Gladman
- Division of Rheumatology, Department of Medicine, University of Toronto, Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada
| |
Collapse
|
19
|
De Rossi SD, Mendonça JA, Palominos PE, Kohem CL, Cestari TF, da Silva Chakr RM. Ultrasonographic and resistance index evaluation of nails in psoriatic arthritis, psoriasis, and control groups: a cross-sectional study. Adv Rheumatol 2021; 61:48. [PMID: 34321109 DOI: 10.1186/s42358-021-00207-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nail psoriasis occurs frequently in patients with psoriatic disease, it can lead to functional impairment, pain, discomfort, decreased quality of life and can also be a predictor for the development of arthritis. Early recognition of this condition can provide early and effective treatment and prevent structural impairment. This study aims to identify nail ultrasonographic characteristics in three groups: psoriasis (PsO), psoriatic arthritis (PsA) and controls patients, to determine if the ultrasonography (US) can identify early signs of nail psoriatic impairment or local inflammation. We conducted nail US to determine nail matrix resistance index (NMRI), nail bed resistance index (NBRI), and power Doppler (PD) and grayscale (GS) parameters in these 3 groups. METHODS Single-center, cross-sectional study. GS, PD, and spectral doppler images of bilateral 2nd and 3rd fingernails were acquired from 35 PsO, 31 PsA, and 35 controls patients. An US equipment with an 18 MHz linear transducer for GS and 8.0 MHz for PD was used. PD, NMRI, NBRI, nail plate thickness (NPT), nail bed thickness (NBT), nail matrix thickness (NMT), and morphostructural characteristics of the trilaminar structure (TS) were evaluated in saved images, blind. RESULTS Mean NMRI and NBRI did not differ between groups. Linear regression analysis detected no relationships between PsO or PsA and NMRI or NBRI. Nail PD grade did not differ between groups. Type I and IV TS changes were more frequent in PsO; types II and III changes were more frequent in PsA (p < 0.001). NPT was greater in PsA and PsO groups than controls: PsA 0.73 ± 0.14 mm, PsO 0.72 ± 0.15 mm, Controls 0.67 ± 0.10 mm (p = 0.001). CONCLUSION Echographic TS characteristics of the nail plate and NPT evaluated by GS are useful and can distinguish PsO and PsA nails from controls. NMRI, NBRI, and US nail microcirculation parameters could not distinguish psoriatic nails. TRIAL REGISTRATION 72762317.4.0000.5327 (Certificate of Presentation of Ethical Appreciation - CAAE - Plataforma Brasil) Avaiable in https://plataformabrasil.saude.gov.br/login.jsf .
Collapse
Affiliation(s)
- Samanta Daiana De Rossi
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. .,Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
| | - José Alexandre Mendonça
- Department of Rheumatology, Celso Pierro Hospital, Pontifícia Universidade Católica de Campinas, São Paulo, Brazil
| | - Penelope Ester Palominos
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Charles Lubianca Kohem
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tania Ferreira Cestari
- Divisiont of Dermatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Mendonça da Silva Chakr
- Division of Rheumatology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| |
Collapse
|
20
|
Gialouri CG, Fragoulis GE. Disease activity indices in psoriatic arthritis: current and evolving concepts. Clin Rheumatol 2021; 40:4427-4435. [PMID: 34003419 DOI: 10.1007/s10067-021-05774-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/18/2021] [Accepted: 05/10/2021] [Indexed: 10/21/2022]
Abstract
Psoriatic arthritis (PsA) is a highly heterogenous disease, with many different clinical manifestations inside or outside of the musculoskeletal system and the skin. It is often accompanied by comorbidities like cardiovascular diseases and mental health disorders. Acute phase reactants are not always elevated and specific markers for diagnosis and/or monitor the disease are lacking thus far. These characteristics possibly reflect the difficulty in agreement about a disease activity index for PsA. Many indices have been proposed over the last years, each of them considering different combinations of disease characteristics. We performed a literature search for relevant articles using PubMed and Embase. No data limits were applied. The keywords "Psoriatic arthritis" OR "PsA" AND "disease activity" AND "index" OR "indices" were used. Reference lists of relevant articles were also reviewed. Articles were also identified through searches of the authors' own files. In this review, we comparatively present the available indices (simple or composite) used for measuring activity in PsA, highlighting their weaknesses, strengths, and disparities. We comment also on the caveats and pitfalls that are encountered in assessment of disease activity, in relation to clinical practice and research. A widely accepted index for measuring disease activity in PsA is lacking. Other parameters, mostly related to patient-reported outcomes and to novel biomarkers might be included in the future, in such indices. Key points • Disease activity in PsA is multiparametric and its assessment is challenging due to many different phenotypes. • Many different indices are currently in use of PsA disease activity assessment. • Each PsA disease activity index has specific pros and cons.
Collapse
Affiliation(s)
- Chrysoula G Gialouri
- Department of Propaedeutic Internal Medicine, Medical School, Rheumatology Unit, "Laiko" General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 str, 11527, FirstGoudi, Athens, Greece
| | - George E Fragoulis
- Department of Propaedeutic Internal Medicine, Medical School, Rheumatology Unit, "Laiko" General Hospital, National and Kapodistrian University of Athens, Agiou Thoma 17 str, 11527, FirstGoudi, Athens, Greece.
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, Scotland.
| |
Collapse
|
21
|
Jones GT, Macfarlane GJ, Forrest Keenan K, McNamee P, Neilson AR, Siebert S, Burden AD, Kay L, Helliwell PS. The BSR-PsA: study protocol for the British Society for Rheumatology psoriatic arthritis register. BMC Rheumatol 2021; 5:19. [PMID: 33993880 PMCID: PMC8126428 DOI: 10.1186/s41927-021-00189-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/10/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Psoriatic arthritis (PsA) presents a unique clinical challenge. Affecting joints, skin, nails, and other organs, it is associated with various comorbidities and has a significant impact on quality of life, social participation and working life. While biologic and other targeted synthetic disease modifying anti-rheumatic drugs (bDMARDs and tsDMARDs) have revolutionised therapy, questions remain about the long-term safety of these agents, and their effectiveness and cost-effectiveness in the real-world clinical setting. METHODS/DESIGN The British Society for Rheumatology Psoriatic Arthritis Register (BSR-PsA) is a prospective registry of patients with PsA, recruited from across Great Britain, who are (a) commencing a bDMARD/tsDMARD; or (b) naïve to all bDMARDs/tsDMARDs. Ethical approval was given by the NHS West of Scotland Research Ethics Committee 3 (reference: 18/WS/0126). Clinical data are extracted from participants' medical records, including symptom onset and diagnosis, joint, skin and nail symptoms, dactylitis and enthesitis. Physical measurements (height, weight and 66/68 joint counts) and a detailed drug history are taken. Participants are also asked to complete questionnaires comprising instruments relating to general health and quality of life, axial disease, sleep and fatigue, impact of disease, functional status, mental health, other symptoms, and occupational status. The study duration is 5 years in the first instance, and all participants are followed up annually until the end of the study. Participants commencing a bDMARD/tsDMARD are also followed up three and six months after the start of therapy. Disease activity, including C-reactive protein, is assessed at each visit; and participants from some centres are invited to donate blood and urine samples for the creation of a biobank. DISCUSSION Complementing data from randomised trials, results from this study will contribute to the evidence base underpinning the clinical management of psoriatic arthritis. Various analyses will determine the effectiveness and safety of bDMARDs/tsDMARDs in the real-world, will examine the clinical and biological predictors of treatment response, and will provide real-world data on the cost-effectiveness of these therapies, as well as providing informative data important to patients such as quality of life and occupational outcomes. TRIAL REGISTRATION The full study protocol is registered on the Open Science Framework ( https://osf.io/jzs8n ).
Collapse
Affiliation(s)
- Gareth T Jones
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK.
| | - Gary J Macfarlane
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Karen Forrest Keenan
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Health Sciences Building, 1st floor, Foresterhill, Aberdeen, AB25 2ZD, UK
| | - Paul McNamee
- Health Economics Research Unit, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Aileen R Neilson
- Usher Institute, Edinburgh Medical School: Molecular, Genetic and Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - A David Burden
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Lesley Kay
- Musculoskeletal Services Directorate, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
22
|
Coates LC, Bushmakin AG, FitzGerald O, Gladman DD, Fallon L, Cappelleri JC, Hsu MA, Helliwell PS. Relationships between psoriatic arthritis composite measures of disease activity with patient-reported outcomes in phase 3 studies of tofacitinib. Arthritis Res Ther 2021; 23:94. [PMID: 33766074 PMCID: PMC7995583 DOI: 10.1186/s13075-021-02474-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/08/2021] [Indexed: 01/22/2023] Open
Abstract
Background In psoriatic arthritis (PsA), further understanding of the relationships between clinical measures and patient-reported outcomes (PROs) is needed. This post hoc analysis evaluated associations between minimal disease activity (MDA) as a continuous outcome (termed ScoreMDA) or Psoriatic Arthritis Disease Activity Score (PASDAS) with selected PROs not included in the composite measures. Methods Data from two phase 3 studies of tofacitinib in PsA (OPAL Broaden [NCT01877668; N = 422]; OPAL Beyond [NCT01882439; N = 394]) were included. MDA (binary outcome) was defined as meeting ≥5/7 criteria. For ScoreMDA, each criterion was assigned a value (1 = true; 0 = false; score range, 0–7; scores ≥5 indicated MDA). For PASDAS (score range, 0–10), higher scores indicated worse disease activity. PROs analyzed included Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Patient’s Assessment of Arthritis Pain visual analog scale (Pain VAS), and EuroQoL-Five Dimensions-Three Level Health Questionnaire visual analog scale (EQ-5D-3L VAS) and utility index. Relationships were evaluated using repeated measures regression models. Results Similar, approximately linear relationships were confirmed between PASDAS or ScoreMDA and PROs in both studies. In OPAL Broaden and OPAL Beyond, a one-point difference in PASDAS was associated with clinically relevant differences in PROs, including EQ-5D-3L VAS (− 6.7 mm, − 6.9 mm), Pain VAS (9.9 mm, 10.7 mm), and FACIT-F (− 2.8, − 3.3). A one-point difference in ScoreMDA was associated with clinically relevant differences in PROs, including EQ-5D-3L VAS (5.0 mm, 5.5 mm) and FACIT-F (1.9, 2.7) in OPAL Broaden and OPAL Beyond, respectively. Conclusions Linear associations between PASDAS or ScoreMDA and PROs provide interpretable and quantifiable metrics between composite clinical measures and PROs, highlighting the importance of these measures in understanding the relevance of treat-to-target goals in PsA. Trial registration ClinicalTrials.gov, NCT01877668. Registered on June 12, 2013. ClinicalTrials.gov, NCT01882439. Registered on June 18, 2013
Collapse
Affiliation(s)
| | | | - Oliver FitzGerald
- Conway Institute for Biomolecular Research, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK.
| |
Collapse
|
23
|
Duruöz MT, Gezer HH, Nas K, Kılıç E, Sargın B, Kasman SA, Alkan H, Şahin N, Cengiz G, Cüzdan N, Gezer İA, Keskin D, Mülkoğlu C, Reşorlu H, Ataman Ş, Bal A, Küçükakkaş O, Yurdakul OV, Melikoğlu MA, Baykul M, Ayhan FF, Bodur H, Çalış M, Çapkın E, Devrimsel G, Gök K, Hizmetli S, Kamanlı A, Keskin Y, Ecesoy H, Kutluk Ö, Şen N, Şendur ÖF, Tekeoğlu İ, Tolu S, Toprak M, Tuncer T. Gender-related differences in disease activity and clinical features in patients with peripheral psoriatic arthritis: A multi-center study. Joint Bone Spine 2021; 88:105177. [PMID: 33771757 DOI: 10.1016/j.jbspin.2021.105177] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/05/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE This study sought to compare disease activity, clinical features, and patient-reported outcomes concerning anxiety, depression, fatigue, function, quality of life, and fibromyalgia between female and male patients with peripheral PsA in a Turkish population. METHODS This multi-center Turkish League Against Rheumatism (TLAR) Network study included 1038 patients (678 females, 360 males) diagnosed with peripheral PsA according to the CASPAR criteria. The demographic and clinic parameters of the patients were recorded. Disease activity was evaluated using the scores of DAS28 and cDAPSA. Remission, minimal disease activity (MDA), and very low disease activity (VLDA) were determined. Health Assessment Questionnaire (HAQ), Short-Form-36 (SF-36), Hospital Anxiety and Depression Scale (HAD), fatigue VAS (0-10), and Fibromyalgia Rapid ScreeningTool (FiRST) were used. Disease activity and patient-reported outcomes were compared in male and female patients, and the predictors of MDA for both genders were analyzed. RESULTS The patients' mean age was 47.6years (SD: 12) for females and 46.3years (SD: 12.3) for males. In terms of DAS28 and cDAPSA, female patients had significantly higher disease activity scores, while male patients had significantly higher remission rates (P<0.05). There was a significant difference in the rate of MDA in favor of males (P<0.05), but not in VLDA. The incidences of dactylitis, enthesitis, tenosynovitis, and inflammatory bowel disease were similar in male and female patients, except for spondylitis, which was higher in males (P<0.05). Overall, although there was no significant between-group difference in age and disease duration, female patients had significantly higher BMI and late-onset disease (P<0.05). Female patients had higher HAD, HAQ, and FiRST and lower SF-36 scores than males (P<0.05). In both male and female patients, the disease activity score of cDAPSA was significantly correlated with the scores of FiRST, HAD, VAS-F, and HAQ (P<0.05). In regression analysis, tender joint count, swollen joint count, PASI, pain VAS, and enthesitis were the MDA predictors in both genders. CONCLUSION In patients with peripheral PsA, males are more likely to develop spondylitis while other extraarticular manifestations are similar. Female patients appear to have lower rates of remission and MDA and higher levels of disease activity. Female patients experience a more severe course of PsA, with higher levels of pain and fatigue, lower quality of life, and increased functional limitations. The predictors of MDA, i.e., tender joint count, swollen joint count, PASI, pain VAS, and enthesitis are similar between the two genders.
Collapse
Affiliation(s)
- Mehmet Tuncay Duruöz
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Halise Hande Gezer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey.
| | - Kemal Nas
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Erkan Kılıç
- Kanuni Training and Research Hospital; Rheumatology Clinic, Trabzon, Turkey
| | - Betül Sargın
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Sevtap Acer Kasman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine, İstanbul, Turkey
| | - Hakan Alkan
- Department of Physical Medicine and Rehabilitation, Pamukkale University School of Medicine, Denizli, Turkey
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Balıkesir University School of Medicine, Balıkesir, Turkey
| | - Gizem Cengiz
- Van Training and Research Hospital; Rheumatology Clinic, Van, Turkey
| | - Nihan Cüzdan
- Balıkesir Atatürk City Hospital, Rheumatology Clinic, Balıkesir, Turkey
| | - İlknur Albayrak Gezer
- Department of Physical Medicine and Rehabilitation, Selçuk University School of Medicine, Konya, Turkey
| | - Dilek Keskin
- Department of Physical Medicine and Rehabilitation, Kırıkkale University School of Medicine, Kırıkkale, Turkey
| | - Cevriye Mülkoğlu
- Department of Physical Medicine and Rehabilitation, Ankara Training and Research Hospital, Ankara, Turkey
| | - Hatice Reşorlu
- Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University School of Medicine, Çanakkale, Turkey
| | - Şebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Ankara University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, University of Health Sciences Ankara Dışkapı Yıldırım Beyazıt Trainig and Research Hospital, Ankara, Turkey
| | - Okan Küçükakkaş
- Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, İstanbul, Turkey
| | - Ozan Volkan Yurdakul
- Department of Physical Medicine and Rehabilitation, Bezmiâlem Foundation University, İstanbul, Turkey
| | - Meltem Alkan Melikoğlu
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Merve Baykul
- Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Fikriye Figen Ayhan
- Department of Physical Medicine and Rehabilitation, Atilim University Medical School, Ankara, Turkey
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Mustafa Çalış
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Gül Devrimsel
- Department of Physical Medicine and Rehabilitation, Recep Tayyip Erdoğan University School of Medicine, Rize, Turkey
| | - Kevser Gök
- Ankara City Hospital; Rheumatology Clinic, Ankara, Turkey
| | - Sami Hizmetli
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ayhan Kamanlı
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Yaşar Keskin
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Atatürk University School of Medicine, Erzurum, Turkey
| | - Hilal Ecesoy
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Meram School of Medicine, Konya, Turkey
| | - Öznur Kutluk
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Nesrin Şen
- Kartal Dr. Lutfi Kirdar Training and Research Hospital, Rheumatology Clinic, İstanbul, Turkey
| | - Ömer Faruk Şendur
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - İbrahim Tekeoğlu
- Division of Rheumatology and Immunology, Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Sena Tolu
- Department of Physical Medicine and Rehabilitation, Medipol University School of Medicine, İstanbul, Turkey
| | - Murat Toprak
- Department of Physical Medicine and Rehabilitation, Yuzuncu Yıl University School of Medicine, Van, Turkey
| | - Tiraje Tuncer
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| |
Collapse
|
24
|
Farkas F, Ikumi N, Elmamoun M, Szentpetery A, FitzGerald O. Comparison of Composite Measure Remission Targets in Psoriatic Arthritis. J Rheumatol 2021; 48:1272-1278. [PMID: 33722944 DOI: 10.3899/jrheum.200556] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To identify (1) which composite measure is the most stringent target of remission; and (2) which disease component target proves the most difficult to achieve in the different states of minimal disease activity (MDA), Composite Psoriatic Disease Activity Index (CPDAI), Disease Activity Index for Psoriatic Arthritis (DAPSA), and clinical DAPSA (cDAPSA) in patients with psoriatic arthritis (PsA). METHODS There were 258 patients with PsA recruited. Disease remission was evaluated comparing 4 different composite measures and using remission cutoffs as previously proposed (very low disease activity [VLDA], CPDAI ≤ 2, DAPSA ≤ 4, cDAPSA ≤ 4). RESULTS Patients met VLDA criteria (MDA 7/7) in 9.0% of visits, DAPSA remission in 19.8%, cDAPSA remission in 23.4% and CPDAI remission in 30.2%. Of 258 patients, MDA criteria (≥ 5/7) were fulfilled in 46.5%. Of those in MDA, VLDA criteria were reached in 25.0%. Patients met the pain visual analog scale (VAS) target in 57.5% of visits when they were in MDA, 43.3% when in low disease activity (MDA 5-6/7), and 44.8% when in CPDAI remission. Multivariate regression analysis revealed that pain VAS was the least likely target to be achieved. Patients with inflammatory-type back pain had significantly higher pain scores; further, a significant relationship was seen between Bath Ankylosing Spondylitis Disease Activity Index and pain VAS. CONCLUSION Based on our analysis, VLDA proved the most stringent target of disease remission in PsA compared to CPDAI, DAPSA, and cDAPSA. The pain VAS target of ≤ 1.5 cm was the most difficult component to achieve. CPDAI ≤ 2 was found to be the least stringent remission target; however, measurements of axial involvement, which contributed to the elevated pain VAS score in patients not achieving VLDA, were included as a domain in CPDAI only.
Collapse
Affiliation(s)
- Flora Farkas
- F. Farkas, MD, St. Vincent's University Hospital, Dublin, Ireland, and Borsod-Abaúj-Zemplén County Center Hospital and University Teaching Hospital, Department of Rheumatology, Miskolc, Hungary
| | - Natsumi Ikumi
- N. Ikumi, MD, St. Vincent's University Hospital, Dublin, Ireland, and Nihon University School of Medicine, Division of Hematology and Rheumatology, Tokyo, Japan
| | - Musaab Elmamoun
- M. Elmamoun, MD, MBBS, MRCPI, St. Vincent's University Hospital, Dublin, Ireland, and Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - Agnes Szentpetery
- A. Szentpetery, MD, PhD, St. Vincent's University Hospital, Dublin, Ireland, and Uppsala University Hospital, Uppsala, Sweden
| | - Oliver FitzGerald
- O. FitzGerald, MD, FRCP, FRCPI, St. Vincent's University Hospital, and Conway Institute for Biomolecular Research, University College Dublin School of Medicine, Dublin, Ireland.
| |
Collapse
|
25
|
Hoepken B, Serrano D, Harris K, Hwang MC, Reveille J. Validation of the Ankylosing Spondylitis Quality of Life assessment tool in patients with non-radiographic axial spondyloarthritis. Qual Life Res 2021; 30:945-954. [PMID: 33128725 PMCID: PMC7952291 DOI: 10.1007/s11136-020-02686-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the psychometric performance of the Ankylosing Spondylitis Quality of Life (ASQoL) scale in patients with non-radiographic axial spondyloarthritis (nr-axSpA) to assess its appropriateness as an outcome measure in future clinical studies. METHODS Patients with active axSpA from a Phase III, randomized, double-blind, placebo-controlled trial (RAPID-axSpA, NCT01087762) were included (N = 325). Modified New York (mNY) classification criteria were used to classify patients as having ankylosing spondylitis or nr-axSpA; those with nr-axSpA were further categorized based on objective signs of inflammation. Psychometric properties of the ASQoL were assessed/documented using a mixture of modern psychometric methods and classical test theory methods. These included exploratory factor analysis and item response theory models to assess the domain structure, test the utility of a single domain relative to subdomains, assess bias, and generate statistics to guide an empirical scoring algorithm. The reliability and validity of scores were evaluated via internal consistency, test-retest reliability, concurrent validity, and known-groups validity. Score responsiveness was assessed via anchor-based clinically meaningful change, supplemented with empirical cumulative distribution function visualizations. RESULTS The ASQoL data were defined by four domains. However, a four-domain solution was found to be inferior to a bifactor solution in which the four domains were included within a total domain. Scoring statistics supported a unit-weighted total score. Within the nr-axSpA population with objective signs of inflammation, the ASQoL mean score had adequate reliability, validity, and ability to detect clinically meaningful change. CONCLUSIONS Our findings suggest that the ASQoL is an appropriate outcome measure in interventional clinical trials in patients with nr-axSpA.
Collapse
Affiliation(s)
- Bengt Hoepken
- UCB Pharma, Alfred-Nobel-Strasse 10, 40789, Monheim am Rhein, Germany.
| | | | | | - Mark C Hwang
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - John Reveille
- McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA
| |
Collapse
|
26
|
Kaeley GS, Eder L, Aydin SZ, Rich P, Bakewell CJ. Nail Psoriasis: Diagnosis, Assessment, Treatment Options, and Unmet Clinical Needs. J Rheumatol 2021; 48:1208-1220. [PMID: 33589557 DOI: 10.3899/jrheum.201471] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE An estimated 40-50% of patients with psoriasis (PsO) have psoriatic nail disease, which is associated with and directly contributes to a greater clinical burden and worse quality of life in these patients. In this review, we examine how recent advances in the use of new diagnostic techniques have led to improved understanding of the link between nail and musculoskeletal manifestations of psoriatic disease (PsD; e.g., enthesitis, arthritis) and we review targeted therapies for nail PsO (NP). METHODS We performed a literature search to identify which systemic therapies approved for the treatment of PsO and/or psoriatic arthritis (PsA) have been evaluated for the treatment of NP, either as a primary or secondary outcome. A total of 1546 articles were identified on February18, 2019, and evaluated for relevance. RESULTS We included findings from 66 articles on systemic therapies for the treatment of NP in PsD. With several scoring systems available for the evaluation of psoriatic nail disease, including varied subtypes and application of the Nail Psoriasis Area Severity Index, there was a high level of methodological heterogeneity across studies. CONCLUSION NP is an important predictor of enthesitis, which is associated with the early stages of PsA; therefore, it is important for rheumatologists and dermatologists to accurately diagnose and treat NP to prevent nail damage and potentially delay the onset and progression of joint disease. Further research is needed to address the lack of both standardized NP scoring systems and well-defined treatment guidelines to improve management of PsD.
Collapse
Affiliation(s)
- Gurjit S Kaeley
- G.S. Kaeley, MRCP, Department of Medicine, University of Florida College of Medicine, Division of Rheumatology, Jacksonville, Florida, USA;
| | - Lihi Eder
- L. Eder, MD, PhD, University of Toronto, Women's College Research Institute, Toronto, Ontario, Canada
| | - Sibel Zehra Aydin
- S.Z. Aydin, MD, University of Ottawa, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Phoebe Rich
- P. Rich, MD, Oregon Dermatology & Research Center, Portland, Oregon, USA
| | | |
Collapse
|
27
|
Ciurea A, Papagiannoulis E, Bürki K, von Loga I, Micheroli R, Möller B, Rubbert-Roth A, Andor M, Bräm R, Müller A, Dan D, Kyburz D, Distler O, Scherer A, Finckh A. Impact of the COVID-19 pandemic on the disease course of patients with inflammatory rheumatic diseases: results from the Swiss Clinical Quality Management cohort. Ann Rheum Dis 2021; 80:238-241. [PMID: 32963052 PMCID: PMC7509948 DOI: 10.1136/annrheumdis-2020-218705] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate whether the transient reduction in rheumatology services imposed by virus containment measures during the COVID-19 pandemic was associated with disease worsening in axial spondyloarthritis (axSpA), rheumatoid arthritis (RA) or psoriatic arthritis (PsA). METHODS Patient-reported disease activity assessed during face-to-face visits and/or via a smartphone application were compared between three periods of each 2 months duration (before, during and after the COVID-19-wave) from January to June 2020 in 666 patients with axSpA, RA and PsA in the Swiss Clinical Quality Management cohort. RESULTS The number of consultations dropped by 52%, whereas the number of remote assessments increased by 129%. The proportion of patients with drug non-compliance slightly increased during the pandemic, the difference reaching statistical significance in axSpA (19.9% vs 13.2% before the pandemic, p=0.003). The proportion of patients with disease flares remained stable (<15%). There was no increase in mean values of the Bath Ankylosing Disease Activity Index, the Rheumatoid Arthritis Disease Activity Index-5 and the Patient Global Assessment in patients with axSpA, RA and PsA, respectively. CONCLUSION A short interruption of in-person patient-rheumatologist interactions had no major detrimental impact on the disease course of axSpA, RA and PsA as assessed by patient-reported outcomes.
Collapse
Affiliation(s)
- Adrian Ciurea
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Kristina Bürki
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Raphael Micheroli
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Burkhard Möller
- Department of Rheumatology, Clinical Immunology and Allergy, Inselspital University Hospital Bern, Bern, Switzerland
| | - Andrea Rubbert-Roth
- Division of Rheumatology, Kantonsspital Sankt Gallen, Sankt Gallen, Switzerland
| | | | - René Bräm
- Swiss Ankylosing Spondylitis Association, Zurich, Switzerland
| | | | - Diana Dan
- Department of Rheumatology, CHUV, Lausanne, Switzerland
| | - Diego Kyburz
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Axel Finckh
- Department of Rheumatology, Geneva University Hospitals, Geneve, Switzerland
| |
Collapse
|
28
|
Fragoulis GE, Evangelatos G, Tentolouris N, Fragkiadaki K, Panopoulos S, Konstantonis G, Iliopoulos A, Chatzidionysiou K, Sfikakis PP, Tektonidou MG. Higher depression rates and similar cardiovascular comorbidity in psoriatic arthritis compared with rheumatoid arthritis and diabetes mellitus. Ther Adv Musculoskelet Dis 2020; 12:1759720X20976975. [PMID: 33343726 PMCID: PMC7727079 DOI: 10.1177/1759720x20976975] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/05/2020] [Indexed: 12/30/2022] Open
Abstract
Background We explore the spectrum of comorbidities in psoriatic arthritis (PsA) patients in comparison with other high comorbidity-burden diseases like rheumatoid arthritis (RA) and diabetes mellitus (DM). Methods Two hundred and fifteen PsA patients, cross-sectionally collected from two tertiary hospitals, were compared with 215 RA and 215 DM patients (age/sex-matched, similar disease duration). Cardiovascular risk factors [hypertension, current smoking, hyperlipidaemia, obesity (body mass index (BMI) ⩾30)], coronary artery disease (CAD), stroke, major adverse cardiac events (MACEs; combined CAD and stroke), depression, osteoporosis and malignancies were recorded. Odds ratios (ORs) for stroke, CAD and MACE were adjusted for age, sex, hypertension, smoking, hyperlipidaemia, BMI, glucocorticoids use and those for depression were adjusted for age, sex, disease duration, skin involvement and smoking. Within the PsA group, associations between comorbidities and demographic/clinical features were assessed. Results Depression [OR (95% confidence interval (CI)): 3.02 (1.57-5.81)], obesity [OR (95% CI): 2.83, (1.65-4.86)] and hyperlipidaemia [OR (95% CI): 1.96 (1.32-2.90)] were more prevalent in PsA compared with RA, while no differences were observed for CAD, stroke, MACE and malignancies. Depression [OR (95% CI): 4.85 (2.37-9.93)] and osteoporosis [OR (95% CI): 6.22 (1.33-29.2)] were more common in PsA than in DM. Hypertension, but not the other cardiovascular risk factors, was more frequent in DM [OR (95% CI) 0.49 (0.33-0.74)]. However, prevalence of stroke, CAD and MACE did not differ between PsA and DM. Within PsA group, depression was associated with age [OR (95% CI): 1.03 (0.99-1.06)], female sex [OR (95% CI): 3.47 (1.51-7.99)] and smoking [OR (95% CI): 2.78 (1.31-5.88)] while MACEs were associated with age [OR (95% CI): 1.08 (1.00-1.17)], male sex [OR (95% CI) for females: 0.26 (0.06-1.23) and hypertension [OR (95% CI): 6.07 (1.12-33.0)]. No differences were recorded in comorbidities between the different PsA phenotypes. Conclusion Depression was more prevalent in PsA compared with RA and DM, while cardiovascular comorbidity was comparable to both groups, supporting the need for their assessment and management.
Collapse
Affiliation(s)
- George E Fragoulis
- Rheumatology Unit, Joint Rheumatology Program, Medical School, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, 75 Mikras Asias Str., Athens, 115 27, Greece
| | | | - Nikolaos Tentolouris
- Diabetology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Kalliopi Fragkiadaki
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Stylianos Panopoulos
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - George Konstantonis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Alexios Iliopoulos
- Rheumatology Department, 417 Army Shared Fund Hospital "NIMTS", Athens, Greece
| | - Katerina Chatzidionysiou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Rheumatology Program, Medical School, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| |
Collapse
|
29
|
Measuring Outcomes in Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:82-109. [DOI: 10.1002/acr.24242] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
|
30
|
Psoriatic arthritis and depressive symptoms: does systemic inflammation play a role? Clin Rheumatol 2020; 40:1893-1902. [PMID: 33009969 DOI: 10.1007/s10067-020-05417-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Depression is commonly associated with psoriatic arthritis (PsA), but its risk factors in these patients are largely unrecognized. Pro-inflammatory cytokines involved in the pathogenesis of PsA have been associated with depression in patients without autoimmune diseases. The aim of this study was to establish whether PsA patients with and without depressive symptoms differed for general or clinical variables and serum cytokines milieu. METHODS One hundred and fifty consecutive patients with PsA were screened for depressive symptoms with Hospital Anxiety and Depression Scale (HADS-D). Patients with and without depressive symptoms were compared according to the prevalence of general risk factors for depression, comorbidities, PsA features and serum IL-6, TNF-α, and IL-17A. RESULTS Fifty-eight patient (38.7%) had a depressive mood. Depressive symptoms were associated with female sex (p = 0.03) and current smoking (p = 0.05). Patients with and without depressive symptoms did not differ for general risk factors for depression and comorbidities. Depressed patients had more frequently psoriatic nail disease (p = 0.02) and significant physical disability (HAQ-DI ≥ 0.5) (p < 0.01) and were more frequently in moderate or high disease activity according to DAPSA score (p = 0.01). Depressed patients had higher serum IL-6 (p < 0.01) and comparable serum IL-17A and TNF-α. A cutoff of 2.27 pg/ml of serum IL-6 had the best ability to predict an HADS-D ≥ 8 (AUC 0.666 ± 0.044; p < 0.01). Multivariate logistic regression analysis confirmed that serum IL-6 ≥ 2.27 pg/ml was independently associated with depressive symptoms (OR 3.5; CI 1.6-7.8; p < 0.01). CONCLUSIONS Higher serum Il-6 is associated with depressive symptoms. This association suggests a direct role of systemic inflammation in the modulation of mood in PsA patients. Key Points • High PsA disease activity and physical disability are associated with depression. • Higher serum levels of IL-6 are independently associated with depression in PsA. • IL-6 might play a direct role in the development of depression in PsA patients.
Collapse
|
31
|
Walsh JA, Wan MT, Willinger C, Husni ME, Scher JU, Reddy SM, Ogdie A. Measuring Outcomes in Psoriatic Arthritis: Comparing Routine Assessment of Patient Index Data and Psoriatic Arthritis Impact of Disease. J Rheumatol 2020; 47:1496-1505. [PMID: 31575704 PMCID: PMC11110026 DOI: 10.3899/jrheum.190219] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the construct validity of Routine Assessment of Patient Index Data 3 (RAPID3) and Psoriatic Arthritis Impact of Disease (PsAID) in patients with psoriatic arthritis (PsA). In examining construct validity, we also addressed scores among subgroups with severe psoriasis, poly articular disease, enthesitis, and dactylitis, and evaluated influences of sociodemographic factors and comorbidities (contextual factors) on these patient-reported outcomes (PRO). METHODS Patients with PsA were enrolled in the Psoriatic Arthritis Research Consortium (PARC) between 2014 and 2016. PARC is a longitudinal observational cohort study conducted at 4 US institutions. In this cross-sectional study, construct validity was assessed by examining Spearman correlation coefficients for RAPID3 and PsAID with physician-reported disease activity measures and other PRO [e.g., Medical Outcomes Study Short Form-12 physical component summary/mental component summary (SF-12 PCS/MCS), Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F)]. Contextual factors and disease subgroups were assessed in multivariable linear regression models with RAPID3 or PsAID12 as outcomes of interest and the hypothesized contextual factors as covariates. RESULTS Among 401 patients enrolled in PARC, 347 completed RAPID3 or PsAID12. Of these, most were white females with a mean age of 51.7 years (SD 14.02). RAPID3 and PsAID were highly correlated (r = 0.90). These measures were also correlated with the SF-12 PCS (r = -0.67) and FACIT-F (r = -0.77). Important contextual factors and disease subgroups included enthesitis, joint counts, education, insurance type, and depression. CONCLUSION RAPID3 and PsAID12 have excellent construct validity in PsA and are strongly correlated despite differing items. Contextual factors (i.e., the presence of depression and obesity) should be considered when interpreting raw scores of the RAPID3 and PsAID12.
Collapse
Affiliation(s)
- Jessica A Walsh
- J.A. Walsh, MD, MBA, A. Ogdie, MD, MSCE, Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Marilyn T Wan
- M.T. Wan, MBChB, MPH, Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | | | | | - Jose U Scher
- J.U. Scher, MD, S.M. Reddy MD, New York University School of Medicine, New York, New York, USA
| | - Soumya M Reddy
- J.U. Scher, MD, S.M. Reddy MD, New York University School of Medicine, New York, New York, USA
| | - Alexis Ogdie
- J.A. Walsh, MD, MBA, A. Ogdie, MD, MSCE, Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia;
| |
Collapse
|
32
|
Cañete JD, Tasende JAP, Laserna FJR, Castro SG, Queiro R. The Impact of Comorbidity on Patient-Reported Outcomes in Psoriatic Arthritis: A Systematic Literature Review. Rheumatol Ther 2020; 7:237-257. [PMID: 32270447 PMCID: PMC7211228 DOI: 10.1007/s40744-020-00202-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION A systematic literature review was conducted with the aim to analyse the impact of comorbidity on patient-reported outcomes (PROs) in patients with psoriatic arthritis (PsA). METHODS A sensitive search strategy of the Medline, Embase and the Cochrane Library (up to March 2019) was applied to retrieve studies for inclusion in this systematic literature review. Abstracts of the ACR and EULAR scientific meetings were also searched. The selection criteria were: (1) patients with PsA (population) with a comorbidity (intervention) and (2) report of any impact of the comorbidity on PROs. Systematic literature reviews, randomized controlled trials and observational were included in this systematic literature review. Two of the authors selected the articles and collected the data. RESULTS Eighteen articles were included in this systematic literature review, with most being cross-sectional studies that included more than 9000 patients with PsA. Some studies analysed the impact of an individual comorbidity, such as fibromyalgia (FM), and in others the analysis was according to the number of comorbidities. The most frequently analysed PROs were function, quality of life and fatigue. Analysis of the studies included in the review showed that patients with a higher number of comorbidities and/or more severe comorbidities reported worse impacts of their disease on function, patient's global assessment (PGA), pain, fatigue, work disability and quality of life. Specifically, FM had a negative impact on the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), function, quality of sleep and quality of life; anxiety and depression had a negative impact on function and fatigue; metabolic syndrome had a negative impact on BASDAI, function, PGA and quality of life; obesity had a negative impact on function and pain; smoking (current and ex-smokers) had a negative impact on pain, function, fatigue, quality of life and overall health; alcohol intake had a negative impact on pain, function, fatigue, quality of life and overall health. CONCLUSIONS The prevalence and impact of medical comorbidity on PROs are very high in patients with PsA.
Collapse
Affiliation(s)
- Juan D Cañete
- Arthritis Unit, Rheumatology Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | | | | | | | - Rubén Queiro
- Rheumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
| |
Collapse
|
33
|
Perruccio AV, Got M, Li S, Ye Y, Gladman DD, Chandran V. Development of a Modified Psoriatic Arthritis Disease Activity Score Using the Medical Outcomes Study Short Form 12 as a Measure of Quality of Life. Arthritis Care Res (Hoboken) 2020; 72:577-582. [PMID: 30875460 DOI: 10.1002/acr.23876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/05/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite measure of psoriatic arthritis (PsA) disease activity. The length of its patient-reported components raises concern about questionnaire burden. The PASDAS includes the Medical Outcomes Study Short Form 36 (SF-36) health survey. We undertook this study to investigate the agreement between the PASDAS and a modified PASDAS (mPASDAS), which substituted the SF-36 with the shortened SF-12. METHODS A total of 100 patients who fulfilled the criteria of the Classification of Psoriatic Arthritis Study Group for PsA were consecutively recruited. All of the PASDAS-required variables were collected. The 12 item responses for SF-12 were extracted from the SF-36 questionnaire. The PASDAS and the mPASDAS were calculated using the SF-36 and SF-12 scores, respectively. A Bland-Altman plot of the mean differences in PASDAS and mPASDAS scores was generated to evaluate agreement. Construct validity was assessed by examining correlations of the PASDAS and the mPASDAS with the Health Assessment Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue subscale, the EuroQol 5-domain instrument (health-related quality of life), and pain scores (range 0-10, visual analog scale). The kappa statistic was used to measure agreement between disease activity states as determined by the PASDAS and mPASDAS. RESULTS The mean ± SD PASDAS and mPASDAS was 3.29 ± 1.39 and 3.24 ± 1.27, respectively. The correlation between the 2 scores was 0.998 (P < 0.0001), and the mean difference was -0.05 (95% confidence interval [95% CI] -0.07, -0.03). Construct validity was found, with nearly identical correlations of the PASDAS and mPASDAS with each of the external health measures. The misclassification rate with the mPASDAS was only 6%. The weighted κ = 0.90 (95% CI 0.82, 0.97). CONCLUSION The mPASDAS may replace the PASDAS in disease activity assessment given the excellent agreement, validity, and low misclassification rate.
Collapse
Affiliation(s)
- Anthony V Perruccio
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Matthew Got
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Suzanne Li
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Yang Ye
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Dafna D Gladman
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vinod Chandran
- University of Toronto and the Krembel Research Institute, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
34
|
Perez-Chada LM, Balak D, Cohen JM, Ogdie A, Merola JF, Gottlieb AB. Measurement properties of instruments assessing psoriatic arthritis symptoms for psoriasis clinical trials: a systematic literature review. Expert Rev Clin Immunol 2020; 16:267-283. [PMID: 32037912 DOI: 10.1080/1744666x.2020.1724090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The International Dermatology Outcome Measures (IDEOM) identified 'Psoriatic Arthritis (PsA) Symptoms' as a core domain to be measured in psoriasis clinical trials. This domain includes the measurement of pain, patient global and physical function. Herein, we evaluated the quality (i.e. measurement properties) of five candidate 'PsA Symptoms' measures: Patient Global Assessment (PGA) for Joints, PGA for PsA, the Routine Assessment Patient Index 3 (RAPID3), the PsA Impact of Disease 9 (PsAID9) and PsAID12.Areas covered: We searched MEDLINE and EMBASE (inception-to-March 2018) for studies assessing the measurement properties of candidate instruments. Two reviewers independently assessed the risk of bias of 12 eligible articles using the COSMIN checklist. For each measurement property, we rated the quality of the evidence as 'high,' 'moderate,' 'low,' or 'very low' (GRADE approach) and classified the results as 'sufficient,' 'insufficient,' or 'inconsistent.' Finally, we provided recommendations.Expert opinion: In PsA, RAPID3 had 'very low' quality evidence for 'sufficient' content validity and no evidence of internal structure. Global assessment instruments had 'very low' quality evidence for 'inconsistent' content validity. PsAID9 and PsAID12 had 'low' evidence for 'sufficient' content validity and were recommended to measure 'PsA Symptoms.' Further validation studies will improve the level of evidence of this recommendation.
Collapse
Affiliation(s)
- Lourdes M Perez-Chada
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Deepak Balak
- Department of Dermatology and Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Alexis Ogdie
- Division of Rheumatology and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph F Merola
- Department of Dermatology and Department of Medicine, Division of Rheumatology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alice B Gottlieb
- Department of Dermatology, Icahn School of Medicine at Mt Sinai, New York, New York, USA
| |
Collapse
|
35
|
Thomsen RS, Nilsen TIL, Haugeberg G, Bye A, Kavanaugh A, Hoff M. Impact of High-Intensity Interval Training on Disease Activity and Disease in Patients With Psoriatic Arthritis: A Randomized Controlled Trial. Arthritis Care Res (Hoboken) 2020; 71:530-537. [PMID: 29882634 DOI: 10.1002/acr.23614] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the impact of high-intensity interval training (HIIT) on disease activity and disease perception in patients with psoriatic arthritis (PsA) and to evaluate whether a potential effect could be sustained for a longer period of time. METHODS We randomly assigned 67 patients with PsA (43 women and 24 men) to an intervention group in which patients performed HIIT for 11 weeks or a control group of patients who were instructed not to change their physical exercise habits. Outcomes were assessed at 3 months and 9 months with the patient's global assessment (PGA), fatigue, and pain scores measured on a 100-mm visual analog scale (VAS), and the composite Disease Activity Score in 44 joints (DAS44) was calculated. We used linear mixed models to calculate the mean difference (95% confidence interval [95% CI]) between groups according to the intent-to-treat principle. RESULTS At 3 months, there was no clear difference in the PGA score (-0.49 [95% CI -10.91, 9.94]), DAS44 (-0.08 [95% CI -0.36, 0.20]), or pain intensity (5.45 [95% CI -4.36, 15.26]) between the groups. However, patients in the intervention group reported less fatigue (-12.83 [95% CI -25.88, 0.23]) than those in the control group. There was no evidence of long-term effects of HIIT on outcomes measured at 9 months. CONCLUSION HIIT showed no clear effects on disease activity markers in patients with PsA, but the intervention (exercise) group reported meaningfully less fatigue after the intervention period. The results of this study suggest that patients with PsA tolerate HIIT without deterioration of disease activity and with improvement in fatigue.
Collapse
Affiliation(s)
- Ruth S Thomsen
- Norwegian University of Science and Technology, and St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Tom I L Nilsen
- Norwegian University of Science and Technology, and St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
| | - Glenn Haugeberg
- Norwegian University of Science and Technology, Trondheim, Norway, Hospital of Southern Norway Trust, Kristiansand, Norway, and Martina Hansens Hospital, Baerum, Norway
| | - Anja Bye
- Norwegian University of Science and Technology, and St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
| | | | - Mari Hoff
- Norwegian University of Science and Technology, and St Olavs Hospital, University Hospital of Trondheim, Trondheim, Norway
| |
Collapse
|
36
|
Assessment of the psychometric properties of patient-reported outcomes of depression and anxiety in systemic lupus erythematosus. Semin Arthritis Rheum 2019; 49:260-266. [DOI: 10.1016/j.semarthrit.2019.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/11/2019] [Accepted: 03/01/2019] [Indexed: 01/12/2023]
|
37
|
Hercogová J, Papp KA, Chyrok V, Ullmann M, Vlachos P, Edwards CJ. AURIEL-PsO: a randomized, double-blind phase III equivalence trial to demonstrate the clinical similarity of the proposed biosimilar MSB11022 to reference adalimumab in patients with moderate-to-severe chronic plaque-type psoriasis. Br J Dermatol 2019; 182:316-326. [PMID: 31206593 PMCID: PMC7027805 DOI: 10.1111/bjd.18220] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND MSB11022 is a proposed adalimumab biosimilar. OBJECTIVES To compare the efficacy, safety and immunogenicity of MSB11022 with reference adalimumab. METHODS AURIEL-PsO was a double-blind randomized controlled equivalence trial, in which patients with moderate-to-severe chronic plaque-type psoriasis were randomized 1 : 1 to MSB11022 or reference adalimumab. The primary end point was ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75) at week 16, with a prespecified equivalence interval of ± 18%. Patients with a ≥50% improvement in PASI at week 16 were eligible to enter a double-blind extension period: patients receiving MSB11022 continued treatment, and patients receiving reference adalimumab were rerandomized 1 : 1 either to continue reference adalimumab or to switch to MSB11022. Other efficacy end points and safety, immunogenicity and pharmacokinetic parameters were evaluated at scheduled visits up to weeks 52 (efficacy and immunogenicity), 54 and 66 (safety). RESULTS In total, 443 patients were randomized. The difference in PASI 75 response rates at week 16 between the treatment arms was -1·9%, and the 95% confidence interval (-7·8% to 4·1%) was within the prespecified equivalence interval. No notable difference in the incidence of treatment-emergent adverse events was observed between treatment arms up to the end of the trial, and no new safety signals were observed. Following treatment switch at week 16, no clinically meaningful differences in safety or immunogenicity were seen between treatment arms through to the end of the observation period. CONCLUSIONS Therapeutic equivalence between MSB11022 and reference adalimumab was demonstrated. AURIEL-PsO provides evidence to support the similarity of both products with regard to efficacy, safety and immunogenicity. What's already known about this topic? Adalimumab is a fully human antitumour necrosis factor-α monoclonal antibody, indicated for the treatment of multiple inflammatory disorders, including psoriasis, psoriatic arthritis, rheumatoid arthritis, inflammatory bowel diseases and ankylosing spondylitis. MSB11022 is a proposed adalimumab biosimilar that has shown structural and functional similarity to the reference product in an extensive analytical comparability exercise. MSB11022 has demonstrated bioequivalence and comparable safety and immunogenicity profiles in a phase I study in healthy volunteers. What does this study add? This phase III study confirmed equivalent efficacy for MSB11022 and reference adalimumab in patients without any immunomodulation comedication in moderate-to-severe chronic plaque-type psoriasis at week 16. The efficacy, safety and immunogenicity of MSB11022 and reference adalimumab were similar over the respective observation periods (week 52 for efficacy and immunogenicity, week 66 for safety). A switch from reference adalimumab to MSB11022 at week 16 did not impact efficacy, safety or immunogenicity.
Collapse
Affiliation(s)
- J Hercogová
- Dermatology Department, 2nd Medical Faculty, Charles University and Na Bulovce Hospital, Prague, Czech Republic
| | - K A Papp
- K Papp Clinical Research and Probity Medical Research Inc., Waterloo, ON, Canada
| | - V Chyrok
- Fresenius Kabi, Eysin, Switzerland
| | | | | | - C J Edwards
- NIHR Clinical Research Facility, University of Southampton, Southampton, U.K
| |
Collapse
|
38
|
Zhao SS, Miller N, Harrison N, Duffield SJ, Dey M, Goodson NJ. Systematic review of mental health comorbidities in psoriatic arthritis. Clin Rheumatol 2019; 39:217-225. [PMID: 31486931 DOI: 10.1007/s10067-019-04734-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/05/2019] [Accepted: 08/01/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE In this systematic review and meta-analysis of psoriatic arthritis (PsA) studies, we pooled data from existing literature to (1) estimate the prevalence of mental health disorders in PsA patients and (2) compare disease activity in PsA patients with and without these comorbidities. METHOD We searched PubMED, Web of Science, Scopus, PsycINFO and the Cochrane Library using a predefined protocol in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Where possible, meta-analysis was performed using random effects model. Prevalence estimates were pooled according to the severity of mental health disorders. RESULTS A total of 24 studies, amounting to 31,227 PsA patients, were included for review. Anxiety and depression were the only consistently reported mental health disorders, defined using a range of screening criteria/thresholds. Anxiety prevalence ranged from 4 to 61% with a pooled estimate of 33% (95%CI 17 to 53%) having at least mild anxiety and 21% (95%CI 14 to 29%) at least moderate. Depression prevalence ranged from 5 to 51%, with 20% (95%CI 8 to 35%) having at least mild and 14% (95%CI 8 to 21%) at least moderate. Only two studies compared disease activity according to the presence of mental health comorbidities; both reported higher disease activity and pain among those with comorbid anxiety and depression. CONCLUSIONS Anxiety and depression are highly prevalent among PsA patients. Studies of other mental health disorders were scarce. More studies are needed on the impact of these comorbidities on disease activity and long-term outcomes.Key Points• One in three patients with psoriatic arthritis has at least mild anxiety, while 1 in 5 reported at least mild depression.• PsA patients with anxiety and/or depression reported greater disease activity.• More research is needed on other mental health comorbidities, particularly sleep, suicide/self-harm and substance misuse.
Collapse
Affiliation(s)
- Sizheng Steven Zhao
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Natasha Miller
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - Nicholas Harrison
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Stephen J Duffield
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Mrinalini Dey
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK
| | - Nicola J Goodson
- Musculoskeletal Biology I, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK.
- Department of Academic Rheumatology, Aintree University Hospital, Liverpool, UK.
| |
Collapse
|
39
|
Kwan A, Katz P, Touma Z. The Assessment of Anxiety and Depression and its Associated Factors in SLE. Curr Rheumatol Rev 2019; 15:90-98. [PMID: 30255761 DOI: 10.2174/1573397114666180926101513] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/13/2018] [Accepted: 09/23/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Depression and anxiety are common neuropsychiatric complaints in patients with Systemic Lupus Erythematosus (SLE). While numerous studies have been performed to investigate the prevalence, impact, and associated factors of depression and anxiety, current literature presents mixed results. In particular, the prevalence of anxiety and depression varies substantially between studies due to methodological limitations, and heterogeneity in defining anxiety and depression, patient selection, and metrics used. Moreover, there is a lack of studies evaluating the validity, reliability, and interpretability of commonly used screening tools for depression and anxiety in SLE patients. RESULT AND CONCLUSION Further investigations should aim to reach a consensus surrounding the role of controversial associated factors in depression and anxiety of SLE patients, while also focusing on the identification of novel factors that have not yet been highlighted in the literature.
Collapse
Affiliation(s)
- Andrew Kwan
- Queen's University, Kingston, Ontario, Canada.,University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Patricia Katz
- Department of Medicine, UCSF, Philip R. Lee Institute for Health Policy Studies, St, San Francisco, CA 94117, United States
| | - Zahi Touma
- University of Toronto Lupus Clinic, Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| |
Collapse
|
40
|
Armstrong AW, Edson-Heredia E, Naegeli AN, Burge R, Poon JL, Anatchkova M, Sun L, Zhu B, Wyrwich KW. Development of the Psoriasis Symptoms Scale (PSS) in patients with moderate-to-severe psoriasis: qualitative and quantitative analyses. J DERMATOL TREAT 2019; 31:452-459. [DOI: 10.1080/09546634.2019.1623370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- April W. Armstrong
- Department of Dermatology, Keck School of Medicine of USC, Los Angeles, CA, USA
| | | | | | - Russel Burge
- Eli Lilly and Company, Indianapolis, IN, USA
- Department of Pharmaceutical Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Cincinnati, OH, USA
| | | | - Milena Anatchkova
- Evidera, Bethesda, MD, USA
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Luna Sun
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Baojin Zhu
- Eli Lilly and Company, Indianapolis, IN, USA
| | | |
Collapse
|
41
|
Perruccio AV, Got M, Li S, Ye Y, Gladman DD, Chandran V. Treating Psoriatic Arthritis to Target: Defining the Psoriatic Arthritis Disease Activity Score That Reflects a State of Minimal Disease Activity. J Rheumatol 2019; 47:362-368. [PMID: 31203221 DOI: 10.3899/jrheum.181472] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The Psoriatic Arthritis Disease Activity Score (PASDAS) is a composite disease activity measure (range 0-10) for psoriatic arthritis (PsA). We aimed to validate a cutoff value of PASDAS that defines minimal disease activity (MDA) state, as well as to validate previously defined PASDAS cutoffs for low and high disease activity. METHODS Patients were prospectively recruited from the University of Toronto PsA clinic according to a standard protocol, and variables necessary to complete the PASDAS and the MDA were collected. Receiver-operating characteristic (ROC) curve analysis determined the optimal PASDAS cutoff discriminating patients in MDA state from those not in MDA. Previously proposed PASDAS disease activity cutoff scores were validated by determining the proportion of patients requiring treatment escalation, a surrogate of active disease, in each of low, moderate, and high disease activity groups. RESULTS One hundred seventy-eight patients [53.9% male, mean PASDAS 3.29 (SD 1.29), 47.8% in MDA] were recruited. ROC curve analysis identified a PASDAS score of 3.2 as the point that maximized the sensitivity and specificity for MDA based on 5 of 7 criteria (sensitivity 88%, specificity 92%, area under the curve 0.96). For MDA based on meeting 6 of 7 and 7 of 7 criteria, PASDAS scores of 2.6 and 2.1 maximized sensitivity and specificity, respectively. An increasing proportion of patients from low to moderate to high disease activity groups required treatment escalation, increasing from 8.1% to 42% to 67%, respectively. CONCLUSION A PASDAS score < 3.2 reflects MDA. This study has externally validated PASDAS cutoff scores previously proposed to differentiate between low, moderate, and high disease activity.
Collapse
Affiliation(s)
- Anthony V Perruccio
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Matthew Got
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Suzanne Li
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Yang Ye
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Dafna D Gladman
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network
| | - Vinod Chandran
- From the Faculty of Medicine; Dalla Lana School of Public Health; Department of Surgery; Division of Rheumatology, Department of Medicine; Institute of Medical Science; Department of Laboratory Medicine and Pathobiology, University of Toronto; Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada. .,A.V. Perruccio, PhD, Faculty of Medicine, and Dalla Lana School of Public Health, and Department of Surgery, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; M. Got, MD, Faculty of Medicine, University of Toronto, Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; S. Li, MMath, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; Y. Ye, MSc, Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; D.D. Gladman, MD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network; V. Chandran, MD, PhD, Faculty of Medicine, and Division of Rheumatology, Department of Medicine, and Institute of Medical Science, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Health Care & Outcomes Research and Arthritis Program, Krembil Research Institute, University Health Network.
| |
Collapse
|
42
|
Measuring psoriatic arthritis symptoms: A core domain in psoriasis clinical trials. J Am Acad Dermatol 2019; 82:54-61. [PMID: 31163240 DOI: 10.1016/j.jaad.2019.05.075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND The International Dermatology Outcome Measures established a set of core domains to be measured in all psoriasis trials. This set requires that symptoms of psoriatic arthritis (PsA) be measured in all psoriasis studies. OBJECTIVE To identify the approach to PsA screening and the most appropriate outcome measure for capturing PsA symptoms. METHODS Following guidelines (ie, the COnsensus-based Standards for the selection of health Measurement INstruments, Core Outcome Measures in Effectiveness Trials Initiative, and Outcome Measures in Rheumatology Handbook), we conducted a consensus-building study that included patients, physicians, industry partners, and patient association representatives. The process consisted of a literature review and quality appraisal of measures for PsA symptoms, a pre-Delphi exercise, a Delphi survey, and a consensus meeting. RESULTS Among the 297 expert participants in the Delphi survey, 87.5% agreed that all patients in a psoriasis trial should be screened for PsA with a validated screening tool. Regarding the measurement of PsA symptoms, the preferred instrument was the Psoriatic Arthritis Impact of Disease-9 (PsAID9), with the Routine Assessment Patient Index Data-3 (RAPID3) representing an acceptable alternative. LIMITATIONS Only International Dermatology Outcome Measures members participated in the consensus meeting. CONCLUSION The overwhelming majority of expert stakeholders agreed that all psoriasis trial participants should be screened for PsA, with PsA symptoms measured by using PsAID9 (or alternatively with RAPID3).
Collapse
|
43
|
Carter K, Walmsley S, Rome K, Turner DE. Health professional views on the assessment and management of foot problems in people with psoriatic arthritis in Australia and New Zealand: a qualitative investigation. BMC Musculoskelet Disord 2019; 20:191. [PMID: 31054575 PMCID: PMC6499957 DOI: 10.1186/s12891-019-2572-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/15/2019] [Indexed: 11/12/2022] Open
Abstract
Background Active foot disease persists in a high proportion of people with psoriatic arthritis despite the availability of pharmacological and non-pharmacological interventions to modify the course of the disease. Limited information exists on the provision of health care for foot disease in psoriatic arthritis. The objective of this study was to explore the views of health professionals on the assessment and management of people with psoriatic arthritis-related foot involvement. Methods Convenience sampling was used to recruit health professionals working in rheumatology outpatient clinics in Sydney, Australia and Auckland, New Zealand. Three focus groups were undertaken to explore the views and experiences of health professionals on the assessment and management of foot problems in people with psoriatic arthritis. All interviews were audio-recorded and transcribed verbatim. Qualitative data was analysed using a constant comparative analytic approach to identify themes. Results A total of seventeen health professionals participated including rheumatologists, podiatrists and a physiotherapist. Key themes derived from the focus groups suggest that health professionals perceived that people with psoriatic arthritis-related foot problems experience suboptimal management from symptom onset, to diagnosis and treatment. Frustration was expressed throughout discussions relating to lack of appropriate training and expertise required for the specialised management of foot problems typically encountered with psoriatic arthritis and poor access for patients to specialist podiatry services. Conclusions This study provides new insight into the perspectives of health professionals on the management of foot problems related to psoriatic arthritis. Deficiencies in the diagnosis, assessment and treatment of foot problems were revealed. To meet the foot health needs of people with psoriatic arthritis, reducing diagnostic delay, improving knowledge and awareness about the disease among people with psoriatic arthritis and health professionals, and increasing specialist podiatry service provision may be required.
Collapse
Affiliation(s)
- Kate Carter
- Podiatry department, School of Science and Health, Western Sydney University, Building 24, Campbelltown Campus, Sydney, Australia.
| | - Steven Walmsley
- Podiatry department, School of Science and Health, Western Sydney University, Building 24, Campbelltown Campus, Sydney, Australia
| | - Keith Rome
- Health and Rehabilitation Research Institute, Faculty of Health and Environmental Science, AUT University, 90 Akoranga Drive, Northcote, Auckland, 0627, New Zealand
| | - Deborah E Turner
- Podiatry department, School of Science and Health, Western Sydney University, Building 24, Campbelltown Campus, Sydney, Australia
| |
Collapse
|
44
|
Johnson K, Ye JY, Chandran V, Gladman DD. A novel role for the psoriatic arthritis impact of disease (PsAID) questionnaire. Semin Arthritis Rheum 2019; 49:241-245. [PMID: 31101369 DOI: 10.1016/j.semarthrit.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/24/2019] [Accepted: 04/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Minimal Disease Activity (MDA) uses the Health Assessment Questionnaire (HAQ) as one criterion. HAQ does not correlate well with disease activity with increased PsA disease duration, and its use in the MDA has been questioned. The Psoriatic Arthritis Impact of Disease (PsAID) was specifically developed for PsA Patients. We aimed to validate the PsAID within our patient cohort and determine if the PsAID can replace the HAQ in the MDA. METHODS Patients were recruited from the PsA clinic and assessed according to a standard protocol including demographics, clinical features and laboratory tests. Descriptive statistics were calculated. PsAID cut-offs for use in the MDA were generated based on the Clinical Disease Activity for Psoriatic Arthritis (cDAPSA). RESULTS 115 patients completed the PsAID. There were 70 males, 45 females, with a mean PsA duration of 18.7 (±11.6) years. Mean scores of PsAID-9 and PsAID-12 were 3.4 (±2.4) and 3.2 (±2.3), respectively. The PsAID correlated moderately well with 9 of the PROMs administered in the clinic (ρ = 0.51-0.78). Four PsAID cutoffs based on cDAPSA were generated for use in the MDA: remission (REM) PsAID-9, REM PsAID-12, low disease activity (LDA) PsAID-9, and LDA PsAID-12. All four versions of the PsAID MDAs had sensitivity greater than 85% with the HAQ-MDA, and three versions of the PsAID-MDA had specificity greater than 85% with the HAQ-MDA. CONCLUSIONS The high sensitivity and specificity of the PsAID-MDA with the HAQ-MDA suggest that the PsAID is an effective replacement for the HAQ in the MDA.
Collapse
Affiliation(s)
- Kishor Johnson
- Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Justine Y Ye
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Vinod Chandran
- Department of Medicine & Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Institute of Medical Science, University Health Network, 399 Bathurst Street 1E-410B, Toronto M5T 2S8, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, Toronto Western Hospital, Institute of Medical Science, University Health Network, 399 Bathurst Street 1E-410B, Toronto M5T 2S8, Ontario, Canada.
| |
Collapse
|
45
|
Wang CTM, Kwan YH, Fong W, Xiong SQ, Leung YY. Factors associated with patient-physician discordance in a prospective cohort of patients with psoriatic arthritis: An Asian perspective. Int J Rheum Dis 2019; 22:1209-1215. [PMID: 30942553 PMCID: PMC6766962 DOI: 10.1111/1756-185x.13568] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 12/22/2022]
Abstract
Objectives To evaluate factors associated with patient‐physician discordance in a multiethnic Asian cohort of psoriatic arthritis (PsA) patients. Methods We used data from a prospective cohort of consecutive patients with PsA fulfilling the Classification Criteria for Psoriatic Arthritis, recruited from a single center in Singapore. Sociodemographic, clinical data and patient‐reported outcomes were collected using a standardized protocol at baseline, 4 months, 8 months, 1 year, 2 years and 5 years. patient‐physician discordance was defined as patient global assessment minus physician global assessment (PGA‐PhGA). We evaluated variables associated with patient‐physician discordance using generalized linear regression to control for within‐subject effect. Results One hundred and fortytwo patients (51.4% male, 66.2% Chinese, mean [SD] age and duration of illness 51.1 [13.8] years and 27.5 [98.3] months) were recruited at baseline. Paired results for PGA and PhGA were available for 291 visits with median (interquartile range) follow‐up time of 11.6 (17) months. In univariable analysis, duration of illness, fatigue, pain, tender and swollen joint count, dactylitis count, and health‐related quality of life (Short Form‐36) domains were significantly correlated with patient‐physician discordance. In multivariable analysis, age, fatigue level, pain score were positively associated with patient‐physician discordance, while swollen joint count and mental health were negatively associated with patient physician discordance. Conclusions Increased age, higher fatigue levels, higher pain score and poorer mental health may explain underestimation of disease activity by physicians. Physicians’ overestimation of disease activity may be explained by higher swollen joint counts.
Collapse
Affiliation(s)
- Charmaine Tze May Wang
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Yu Heng Kwan
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
| | - Warren Fong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
| | - Shu Qin Xiong
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore
| | - Ying Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore City, Singapore.,Duke-NUS Medical School, Singapore City, Singapore
| |
Collapse
|
46
|
Gladman DD, Orbai AM, Klitz U, Wei JCC, Gallo G, Birt J, Rathmann S, Shrom D, Marzo-Ortega H. Ixekizumab and complete resolution of enthesitis and dactylitis: integrated analysis of two phase 3 randomized trials in psoriatic arthritis. Arthritis Res Ther 2019; 21:38. [PMID: 30696483 PMCID: PMC6350390 DOI: 10.1186/s13075-019-1831-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/18/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Ixekizumab improves signs/symptoms of psoriatic arthritis (PsA). We present an integrated analysis of baseline disease burden and post-baseline outcomes in ixekizumab-treated patients with enthesitis or dactylitis. METHODS Data from SPIRIT-P1 and SPIRIT-P2 were integrated. Patients with PsA were randomized to 80-mg ixekizumab every 4 weeks (IXEQ4W) or 2 weeks (IXEQ2W), after a 160-mg starting dose, or to placebo. Inadequate responders at week 16 received rescue therapy. Among patients with baseline enthesitis (Leeds Enthesitis Index [LEI] > 0) or dactylitis (Leeds Dactylitis Index-Basic [LDI-B] > 0), baseline characteristics and disease burden were reported. At week 24, LEI and LDI-B (percentage of patients with resolution [LEI = 0, LDI-B = 0]) were assessed. In pooled treatment groups, the impact of enthesitis or dactylitis resolution on health-related quality of life (HRQoL) (EuroQol-5 Dimensions Visual Analogue Scale [EQ-5D VAS]), physical function (Health Assessment Questionnaire-Disability Index [HAQ-DI]), and pain was assessed. RESULTS The integrated analysis set comprised 679 patients; of these, 60% (n = 403 of 675) had baseline enthesitis (LEI > 0) and 23% (n = 155 of 676) had baseline dactylitis (LDI > 0). At week 24, ixekizumab-treated patients experienced significantly more resolution than placebo of enthesitis (39% IXEQ4W, 35% IXEQ2W, 21% placebo) and dactylitis (78% IXEQ4W, 65% IXEQ2W, 24% placebo). Furthermore, at entheseal points measured by the LEI, ixekizumab-treated patients had significantly higher resolution of enthesitis compared to placebo. At week 24, among all placebo- and ixekizumab-treated patients, resolution of enthesitis was associated with improvements in function and HRQoL whereas dactylitis resolution was associated with more limited improvements. The least squares mean HAQ-DI improvements from baseline were - 0.44 and - 0.25 for patients who did/did not resolve enthesitis, and - 0.41 and - 0.31 for patients who did/did not resolve dactylitis. EQ-5D VAS improvements were 12.3 and 5.8 for patients who did/did not resolve enthesitis, and 10.8 and 9.8 for patients who did/did not resolve dactylitis. CONCLUSIONS Among patients with pre-existing enthesitis or dactylitis, IXEQ2W- and IXEQ4W-treatment resulted in significant improvements in enthesitis and dactylitis. Enthesitis resolution was associated with improvements in patients' function, pain, and HRQoL. TRIAL REGISTRATION ClinicalTrials.gov, NCT01695239 , registered on September 25, 2012, and NCT02349295 , registered on October 10, 2014.
Collapse
Affiliation(s)
- Dafna D Gladman
- Division of Rheumatology, Department of Medicine, Centre for Prognosis Studies in The Rheumatic Diseases, University of Toronto, Krembil Research Institute, Toronto Western Hospital, 399 Bathurst St. 1E-410B, Toronto, Ontario, M5T 2S8, Canada.
| | - Ana-Maria Orbai
- Psoriatic Arthritis Program, Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Uta Klitz
- Rheumazentrum Ruhrgebiet, Claudiusstr 45, 44649, Herne, Germany
| | - James Cheng-Chung Wei
- Institute of Medicine, Chinese Medicine Clinical Trial Center, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Julie Birt
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - David Shrom
- Eli Lilly and Company, Indianapolis, IN, USA
| | - Helena Marzo-Ortega
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
47
|
Strand V, de Vlam K, Covarrubias-Cobos JA, Mease PJ, Gladman DD, Chen L, Kudlacz E, Wu J, Cappelleri JC, Hendrikx T, Hsu MA. Effect of tofacitinib on patient-reported outcomes in patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors in the phase III, randomised controlled trial: OPAL Beyond. RMD Open 2019; 5:e000808. [PMID: 30713722 PMCID: PMC6340607 DOI: 10.1136/rmdopen-2018-000808] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/05/2018] [Accepted: 10/13/2018] [Indexed: 01/27/2023] Open
Abstract
Objectives Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). Patient-reported outcomes (PROs) were evaluated in patients with PsA with inadequate responses to tumour necrosis factor inhibitors (TNFi-IR) in a 6-month, phase III randomised controlled trial (OPAL Beyond [NCT01882439]). Methods Patients (N=394) received tofacitinib 5 or 10 mg twice daily or placebo (advancing to tofacitinib 5 or 10 mg twice daily at month 3). Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences and scores ≥normative values were determined in Patient Global Assessment of disease activity (PtGA), Pain, Patient Global Joint and Skin Assessment (PGJS), Short Form-36 Health Survey version 2 (SF-36v2), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), EuroQol 5-Dimensions-3-level (EQ-5D-3L), EQ-VAS and Ankylosing Spondylitis Quality of Life (ASQoL). Nominal p values are without multiple comparison adjustments. Results At month 3, PtGA, Pain, PGJS, SF-36v2 Physical Component Summary (PCS), physical functioning (PF), bodily pain (BP), vitality and social functioning (SF) domains, FACIT-Fatigue Total score, EQ-5D-3L pain/discomfort, EQ-VAS and ASQoL scores exceeded placebo with both tofacitinib doses (role physical [RP] with 10 mg twice daily only; p≤0.05). Patients reporting improvements ≥MCID (%) in PtGA, PGJS, Pain, ASQoL and SF-36v2 PCS, PF, RP, BP, SF (both tofacitinib doses) exceeded placebo (p≤0.05). Conclusion TNFi-IR patients with PsA receiving tofacitinib reported statistically and clinically meaningful improvements in PROs versus placebo over 3 months, which were maintained to month 6. Despite lower baseline scores, these improvements were similar to the csDMARD-IR TNFi-naive OPAL Broaden trial.
Collapse
Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Dafna D Gladman
- University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | - Joseph Wu
- Pfizer Inc, Groton, Connecticut, USA
| | | | | | | |
Collapse
|
48
|
Strand V, de Vlam K, Covarrubias-Cobos JA, Mease PJ, Gladman DD, Graham D, Wang C, Cappelleri JC, Hendrikx T, Hsu MA. Tofacitinib or adalimumab versus placebo: patient-reported outcomes from OPAL Broaden-a phase III study of active psoriatic arthritis in patients with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs. RMD Open 2019; 5:e000806. [PMID: 30713721 PMCID: PMC6340575 DOI: 10.1136/rmdopen-2018-000806] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/18/2018] [Accepted: 10/18/2018] [Indexed: 01/11/2023] Open
Abstract
Objectives Tofacitinib is an oral Janus kinase inhibitor for treatment of psoriatic arthritis (PsA). We evaluated patient-reported outcomes (PROs) in patients with PsA refractory to ≥1 conventional synthetic disease-modifying antirheumatic drug (csDMARD-IR) and tumour necrosis factor inhibitor-naïve in a 12-month, phase III randomised controlled trial (OPAL Broaden [NCT01877668]). Methods Patients (N=422) received tofacitinib 5 mg or 10 mg twice daily, adalimumab 40 mg subcutaneously every 2 weeks or placebo advancing to tofacitinib 5 mg or 10 mg twice daily at month 3. Least squares mean changes from baseline and percentages of patients reporting improvements ≥minimum clinically important differences (MCID); and scores ≥normative values in: Patient Global Assessment of disease activity (PtGA), Pain, Patient Global Joint and Skin Assessment (PGJS), Short Form-36 Health Survey version 2 (SF-36v2), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue), EuroQol 5-Dimensions-3-level questionnaire (EQ-5D-3L) and Ankylosing Spondylitis Quality of Life (ASQoL) were determined. Nominal p values were cited without multiple comparison adjustments. Results At month 3, PtGA, Pain, PGJS, FACIT-Fatigue, EQ-5D-3L, ASQoL and SF-36v2 Physical Component Summary (PCS), physical functioning (PF), bodily pain (BP) and vitality domain scores exceeded placebo with both tofacitinib doses (p≤0.05); SF-36v2 social functioning with 5 mg twice daily (p≤0.05). Percentages reporting improvements ≥MCID in PtGA, Pain, PGJS, FACIT-Fatigue, ASQoL and SF-36v2 PCS, PF, BP and general health scores exceeded placebo with both tofacitinib doses (p≤0.05) and were similar with adalimumab. Conclusion csDMARD-IR patients with active PsA reported statistically and clinically meaningful improvements in PROs with tofacitinib compared with placebo at Month 3.
Collapse
Affiliation(s)
- Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, California, USA
| | - Kurt de Vlam
- Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | | | - Philip J Mease
- Swedish Medical Center and University of Washington, Seattle, Washington, USA
| | - Dafna D Gladman
- University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
49
|
Gorlier C, Orbai AM, Puyraimond-Zemmour D, Coates LC, Kiltz U, Leung YY, Palominos P, Cañete JD, Scrivo R, Balanescu A, Dernis E, Tälli S, Ruyssen-Witrand A, Soubrier M, Aydin SZ, Eder L, Gaydukova I, Lubrano E, Kalyoncu U, Richette P, Husni ME, de Wit M, Smolen JS, Gossec L. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries. Ann Rheum Dis 2018; 78:201-208. [DOI: 10.1136/annrheumdis-2018-214140] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/15/2018] [Accepted: 10/27/2018] [Indexed: 11/03/2022]
Abstract
BackgroundThe objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients’ and physicians’ perspectives.MethodsIn ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA <14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally.ResultsOf 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12–0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions.ConclusionIn this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.
Collapse
|
50
|
Kerschbaumer A, Smolen JS, Aletaha D. Disease activity assessment in patients with psoriatic arthritis. Best Pract Res Clin Rheumatol 2018; 32:401-414. [PMID: 31171311 DOI: 10.1016/j.berh.2018.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 07/26/2018] [Accepted: 07/28/2018] [Indexed: 11/27/2022]
Abstract
Psoriatic arthritis (PsA) is an inflammatory disease in patients with a personal or family history of psoriasis. While synovitis is the major hallmark, enthesitis, dactylitis, axial inflammation, and skin and nail involvement are variable in prevalence and severity. The assessment of disease activity is important to determine the treatment target ("Treat-to-Target") as well as early response to therapy, because a prolonged ineffective medication may not only be associated with an adverse disease outcome but constitutes a waste of individual and/or societal expenses. Various measures of disease activity have been established for all manifestations individually ('uni-dimensional approach') or by combining such measures into a single umbrella score ('multi-dimensional approach'). Because pathogeneses and therapeutic responsiveness differ among individual domains, a uni-dimensional approach is preferred. The major uni-dimensional index is the Disease Activity index for PSoriatic Arthritis, which provides a continuous scale and allows calculating disease activity at any point in time, determining response to therapy and defining disease activity states, such as remission, as a treatment target. The assessment of the various domains by individual and combined indices is discussed.
Collapse
Affiliation(s)
- Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Austria
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Austria.
| |
Collapse
|