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Webster DE, Haberman RH, Perez-Chada LM, Tummalacherla M, Tediarjo A, Yadav V, Neto EC, MacDuffie W, DePhillips M, Sieg E, Catron S, Grant C, Francis W, Nguyen M, Yussuff M, Castillo RL, Yan D, Neimann AL, Reddy SM, Ogdie A, Kolivras A, Kellen MR, Mangravite LM, Sieberts SK, Omberg L, Merola JF, Scher JU. Clinical Validation of Digitally Acquired Clinical Data and Machine Learning Models for Remote Measurement of Psoriasis and Psoriatic Arthritis: A Proof-of-Concept Study. J Rheumatol 2024; 51:781-789. [PMID: 38879192 DOI: 10.3899/jrheum.2024-0074] [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] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVE Psoriatic disease remains underdiagnosed and undertreated. We developed and validated a suite of novel, sensor-based smartphone assessments (Psorcast app) that can be self-administered to measure cutaneous and musculoskeletal signs and symptoms of psoriatic disease. METHODS Participants with psoriasis (PsO) or psoriatic arthritis (PsA) and healthy controls were recruited between June 5, 2019, and November 10, 2021, at 2 academic medical centers. Concordance and accuracy of digital measures and image-based machine learning models were compared to their analogous clinical measures from trained rheumatologists and dermatologists. RESULTS Of 104 study participants, 51 (49%) were female and 53 (51%) were male, with a mean age of 42.3 years (SD 12.6). Seventy-nine (76%) participants had PsA, 16 (15.4%) had PsO, and 9 (8.7%) were healthy controls. Digital patient assessment of percent body surface area (BSA) affected with PsO demonstrated very strong concordance (Lin concordance correlation coefficient [CCC] 0.94 [95% CI 0.91-0.96]) with physician-assessed BSA. The in-clinic and remote target plaque physician global assessments showed fair-to-moderate concordance (CCCerythema 0.72 [0.59-0.85]; CCCinduration 0.72 [0.62-0.82]; CCCscaling 0.60 [0.48-0.72]). Machine learning models of hand photos taken by patients accurately identified clinically diagnosed nail PsO with an accuracy of 0.76. The Digital Jar Open assessment categorized physician-assessed upper extremity involvement, considering joint tenderness or enthesitis (AUROC 0.68 [0.47-0.85]). CONCLUSION The Psorcast digital assessments achieved significant clinical validity, although they require further validation in larger cohorts before use in evidence-based medicine or clinical trial settings. The smartphone software and analysis pipelines from the Psorcast suite are open source and freely available.
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Affiliation(s)
- Dan E Webster
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Rebecca H Haberman
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Lourdes M Perez-Chada
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghasyam Tummalacherla
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Aryton Tediarjo
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Vijay Yadav
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Elias Chaibub Neto
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Woody MacDuffie
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | | | - Eric Sieg
- M. DePhillips, BS, E. Sieg, BS, SDP Digital, Seattle, Washington, USA
| | - Sydney Catron
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Carly Grant
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wynona Francis
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marina Nguyen
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Muibat Yussuff
- L.M. Perez-Chada, MD, MMSc, C. Grant, BS, W. Francis, BS, M. Nguyen, BS, M. Yussuff, BS, Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rochelle L Castillo
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Di Yan
- D. Yan, MD, A.L. Neimann, MD, MSCE, Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrea L Neimann
- D. Yan, MD, A.L. Neimann, MD, MSCE, Ronald O. Perelman Department of Dermatology, New York University Grossman School of Medicine, New York, New York, USA
| | - Soumya M Reddy
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA
| | - Alexis Ogdie
- A. Ogdie, MD, MSCE, Department of Medicine, Division of Rheumatology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Athanassios Kolivras
- A. Kolivras, MD, PhD, Departments of Dermatology and Dermatopathology, Saint-Pierre, Brugmann and Queen Fabiola Children University Hospitals, Université Libre de Bruxelles, Brussels, and UCB Pharma, Brussels, Belgium
| | - Michael R Kellen
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Lara M Mangravite
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Solveig K Sieberts
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Larsson Omberg
- D.E. Webster, PhD, M. Tummalacherla, MSE, A. Tediarjo, BS, V. Yadav, MS, E. Chaibub Neto, PhD, W. MacDuffie, MS, M.R. Kellen, PhD, L.M. Mangravite, PhD, S.K. Sieberts, PhD, L. Omberg, PhD, Sage Bionetworks, Seattle, Washington, USA
| | - Joseph F Merola
- J.F. Merola, MD, MMSc, Department of Dermatology and Department of Medicine, Division of Rheumatology, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jose U Scher
- R.H. Haberman, MD, MSCI, S. Catron, BS, R.L. Castillo, MD, MSCI, S.M. Reddy, MD, J.U. Scher, MD, Department of Medicine, Division of Rheumatology, New York University Grossman School of Medicine and NYU Psoriatic Arthritis Center, NYU Langone Health, New York, New York, USA;
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Wilk M, Michelsen B, Łosińska K, Kavanaugh A, Korkosz M, Haugeberg G. Exploring 5-year changes in general and skin health-related quality of life in psoriatic arthritis patients. Rheumatol Int 2024; 44:675-685. [PMID: 38319377 DOI: 10.1007/s00296-024-05536-1] [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: 12/20/2023] [Accepted: 01/04/2024] [Indexed: 02/07/2024]
Abstract
Psoriatic arthritis (PsA) carries a severe disease burden, often leading to deterioration of health-related quality of life (HRQoL). Different comorbidities that are relatively prevalent in PsA are also responsible for compromised HRQoL. To assess real-world data of a 5-year follow-up cohort of PsA patients, focusing on changes in general HRQoL, skin HRQoL, and comorbidities. In this prospective observational study, 114 outpatients diagnosed with PsA were examined at baseline and after 5 years. Data collection included demographics, clinical disease activity measures, and patient-reported outcome measures (PROMs). General HRQoL was assessed with a 15D instrument, and skin HRQoL was assessed with the Dermatology Life Quality Index (DLQI). During the 5-year follow-up, no significant deterioration in HRQoL assessed by 15D (23.53 vs. 23.08, p = 0.85) and DLQI (3.48 vs. 2.68, p = 0.07) was observed. There was no observed decline in other PROMs. The mean total number of comorbidities increased (1.13 vs. 1.39, p < 0.01). A significant improvement in disease activity measures, including 66/68 swollen/tender joint count, Disease Activity Index for Psoriatic Arthritis (all p < 0.01), and Psoriatic Arthritis Severity Index (p = 0.04) was seen. A higher proportion of patients at 5 years were treated with b/tsDMARDs (37.7% vs. 46.5%, p = 0.03). Despite an increased number of comorbidities over 5 years, our PsA cohort showed no decline in HRQoL. This can be attributed to the widespread adoption of modern treatments, leading to improved disease control and the preservation of baseline HRQoL.
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Affiliation(s)
- Mateusz Wilk
- Division of Rheumatology and Immunology, University Hospital, Jakubowskiego 2, 30-688, Kraków, Poland.
| | | | - Katarzyna Łosińska
- Division of Rheumatology and Immunology, University Hospital, Jakubowskiego 2, 30-688, Kraków, Poland
| | - Arthur Kavanaugh
- Department of Medicine, School of Medicine, University of California, La Jolla, San Diego, CA, USA
| | - Mariusz Korkosz
- Division of Rheumatology and Immunology, University Hospital, Jakubowskiego 2, 30-688, Kraków, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - Glenn Haugeberg
- Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Burshtein J, Shah M, Zakria D, Lockshin B, Crowley J, Merola JF, Gordon K, Shahriari M, Korman NJ, Chovatiya R, Kalb R, Lebwohl M. The Efficacy and Safety of Bimekizumab for Plaque Psoriasis: An Expert Consensus Panel. Dermatol Ther (Heidelb) 2024; 14:323-339. [PMID: 38340237 PMCID: PMC10891030 DOI: 10.1007/s13555-024-01099-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/12/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Psoriasis is a chronic inflammatory condition affecting the skin, joints, and several other organ systems with significant disease burden. Bimekizumab is the first monoclonal antibody targeting both interleukin (IL)-17A and interleukin-17F and has demonstrated efficacy for treating moderate to severe psoriasis. Limited guidelines exist for incorporating this drug into clinical practice. The purpose of this study was for a panel of experts in psoriasis management to synthesize current literature and provide consensus statements with guidance on use of bimekizumab. METHODS A comprehensive literature search of PubMed, Scopus, and Google Scholar was completed for English-language original research articles on the use of bimekizumab for moderate to severe psoriasis and psoriatic arthritis. A panel of nine dermatologists with significant expertise in treatment of psoriasis gathered to review the articles and create consensus statements on this new medication. A modified Delphi process was used to approve each statement and a strength of recommendation was assigned using Strength of Recommendation Taxonomy criteria. RESULTS The literature search produced 102 articles that met criteria. A thorough screening of the studies for relevance to the research question resulted in 19 articles. These were distributed to all panelists for review prior to a roundtable discussion. The panel unanimously voted to adopt 14 consensus statements and recommendations, 12 of which were given a strength of "A", one of which was given a strength of "B", and one of which was given a strength of "C". CONCLUSION Bimekizumab results in rapid and long-lasting clinical improvement for patients with moderate to severe plaque psoriasis and psoriatic arthritis. It has demonstrated superior efficacy when compared to several other biologics. The safety profile is consistent with other biologics, except for an increased incidence of oropharyngeal candidiasis.
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Affiliation(s)
- Joshua Burshtein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Milaan Shah
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Danny Zakria
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Benjamin Lockshin
- US Dermatology Partners, Rockville, MD, USA
- Department of Dermatology, Georgetown University Medical Center, Washington, DC, USA
| | - Jeff Crowley
- Bakersfield Dermatology and Skin Cancer Medical Group, Bakersfield, CA, USA
| | - Joseph F Merola
- Department of Dermatology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ken Gordon
- Medical College of Wisconsin, Milwaukee, WI, USA
| | - Mona Shahriari
- Department of Dermatology, Yale University, New Haven, CT, USA
| | - Neil J Korman
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Raj Chovatiya
- Department of Dermatology, Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Robert Kalb
- SUNY at Buffalo School of Medicine and Biomedical Sciences, Department of Dermatology, Buffalo Medical Group, Buffalo, NY, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Łosińska K, Michelsen B, Kavanaugh A, Korkosz M, Haugeberg G. Psoriatic arthritis: improvement in outcomes but persistent sex difference - 5-year follow-up study of a Norwegian outpatient clinic population. Scand J Rheumatol 2024; 53:10-20. [PMID: 37656147 DOI: 10.1080/03009742.2023.2247703] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/10/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE This study aimed to explore long-term changes in disease activity and remission rates, and potential sex-related differences in these outcomes, in psoriatic arthritis (PsA) patients treated in an outpatient clinic. METHOD This prospective longitudinal cohort study included 114 patients. The Disease Activity Index for Psoriatic Arthritis (DAPSA), clinical DAPSA (cDAPSA), 28-joint Disease Activity Score (DAS28), Simplified and Clinical Disease Activity Indices (SDAI, CDAI), Boolean remission for PsA, and minimal and very low disease activities (MDA, VLDA) were assessed. For group characteristics, parametric statistics and linear regression were used. RESULTS At 5 year follow-up, improvement was noted for multiple measures reflecting disease activity and patient-reported outcomes. Statistically significant increases in remission rates were observed using DAS28 (+21.2%), CDAI (+9.7%), and cDAPSA (+7.6%), but not SDAI, DAPSA, Boolean remission, MDA, or VLDA. During the study period, the proportion of patients treated with biological disease-modifying anti-rheumatic drugs (bDMARDs) increased from 37.7% to 48.3% (p = 0.007). At baseline, women reported higher pain and fatigue, and had higher tender joint counts, DAPSA, cDAPSA, SDAI, CDAI, and DAS28 than men. Despite higher mean baseline C-reactive protein, men more often achieved remission, regardless of the definition applied. A higher proportion of men than women was treated with bDMARDs (baseline: 46.6% vs 28.6%; follow-up: 58.6% vs 33.9%). CONCLUSION This study adds evidence supporting recent improvements in PsA outcomes. Women had higher disease activity and were less likely to achieve remission than men. Despite progress in achieving remission goals, there is still room for improvement in therapeutic approaches for PsA patients.
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Affiliation(s)
- K Łosińska
- Division of Rheumatology and Immunology, University Hospital, Krakow, Poland
| | - B Michelsen
- Research Department, Sørlandet Hospital, Kristiansand, Norway
| | - A Kavanaugh
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - M Korkosz
- Division of Rheumatology and Immunology, University Hospital, Krakow, Poland
- Department of Rheumatology and Immunology, Jagiellonian University Medical College, Krakow, Poland
| | - G Haugeberg
- Department of Internal Medicine, Sørlandet Hospital, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Mulder MLM, van Hal TW, van den Hoogen FHJ, de Jong EMGJ, Vriezekolk JE, Wenink MH. Measuring disease activity in psoriatic arthritis: PASDAS implementation in a tightly monitored cohort reveals residual disease burden. Rheumatology (Oxford) 2021; 60:3165-3175. [PMID: 33331947 DOI: 10.1093/rheumatology/keaa766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/10/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We aimed to investigate the disease activity and overall disease burden of (subgroups of) patients with PsA using the Psoriatic Arthritis Disease Activity Score (PASDAS) in an already tightly monitored cohort. METHODS This is a cross-sectional study evaluating data from the first visit of 855 PsA patients after implementation of the PASDAS in our tightly monitored cohort [e.g. DAS 28 (DAS28) was provided as an anchor]. Differences in clinical outcomes between subgroups of patients using established cut-offs for disease activity status [i.e. very low (VLDA), low (LDA), moderate (MDA), and high disease activity (HDA)] were examined. RESULTS Based on the PASDAS, 53.1% of patients were in VLDA/LDA. 29.5% of patients had ≥1 swollen joint, 20.6% had ≥1 enthesitis index point and 3.0% had active dactylitis. Based on DAS28, 77.5% of the patients were in VLDA/LDA. Patients reaching both DAS28 VLDA/LDA status and PASDAS VLDA/LDA status [N = 445 (52.0%)] were compared with patients reaching only DAS28 VLDA/LDA status [N = 218 (25.5%)]. For these latter patients, significantly worse scores on separate parameters were found in measures used for PASDAS/DAS28 calculation (e.g. swollen and tender joint count and patient's visual analogue scale global disease activity) as well as other disease measures (e.g. function and inflammatory back pain). This result remained, even when the stricter VLDA cut-off was used for the DAS28. CONCLUSION PASDAS implementation uncovered relevant residual disease activity in a quarter of patients previously assessed as being in DAS28 VLDA/LDA, underscoring the potential value of PASDAS measurements in PsA clinical care.
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Affiliation(s)
- Michelle L M Mulder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tamara W van Hal
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.,Department of Rheumatic Diseases Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elke M G J de Jong
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Mark H Wenink
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
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Ballegaard C, Skougaard M, Guldberg-Møller J, Nissen CV, Amris K, Jørgensen TS, Dreyer L, Kristensen LE. Comorbidities, pain and fatigue in psoriatic arthritis, psoriasis and healthy controls: a clinical cohort study. Rheumatology (Oxford) 2021; 60:3289-3300. [PMID: 33325531 DOI: 10.1093/rheumatology/keaa780] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 10/16/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES To explore the prognostic value of pre-specified comorbidities on treatment outcomes in PsA, and to compare baseline data with cutaneous psoriasis without arthritis and healthy controls (HC). METHODS Patients initiating conventional synthetic/biological disease-modifying antirheumatic drugs were enrolled in this clinical observational cohort study, and data on comorbidities, and clinical and patient-reported outcomes were retrieved at baseline and after 4 months. Pearson's chi-squared tests were performed to investigate the prognostic value of pre-specified comorbidities and achievement of ACR20, DAPSA50 and MDA. Mann-Whitney U tests were used to compare OMERACT PsA Core Outcome Set (COS) measures at baseline and follow-up for the pre-specified comorbidities. RESULTS A total of 100 PsA patients were included at baseline. Statistically significantly fewer patients with obesity achieved DAPSA50 compared with patients without obesity (P =0.035), and fewer patients with hypertension (P =0.034) and Charlson Comorbidity Index (CCI) ≥1 (P =0.027), respectively, achieved MDA compared with patients without these comorbidities. Patients with obesity, hypertension, widespread pain, and CCI ≥1 had significantly worse COS measures at follow-up compared with patients without these comorbidities. At baseline, patients with PsA had higher disease burden compared with patients with cutaneous psoriasis and HC, including higher pain (P <0.001) and fatigue (P <0.001) scores, and more widespread pain (P =0.002). CONCLUSION Obesity, hypertension and CCI ≥1 were prognostic factors for poorer treatment outcome rates in PsA. Pain and fatigue were more frequently reported among patients with PsA compared with patients with cutaneous psoriasis and HC. TRIAL REGISTRATION The Danish National Committee on Health Research Ethics: H-15009080; Data Protection Agency: 2012-58-0004; ClinicalTrials.gov: NCT02572700.
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Affiliation(s)
- Christine Ballegaard
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Marie Skougaard
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Jørgen Guldberg-Møller
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Christoffer V Nissen
- Department of Dermatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Kirstine Amris
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Tanja S Jørgensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Lene Dreyer
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - Lars E Kristensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
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Haugeberg G, Michelsen B, Kavanaugh A. Impact of skin, musculoskeletal and psychosocial aspects on quality of life in psoriatic arthritis patients: A cross-sectional study of outpatient clinic patients in the biologic treatment era. RMD Open 2021; 6:rmdopen-2020-001223. [PMID: 32409518 PMCID: PMC7299507 DOI: 10.1136/rmdopen-2020-001223] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/14/2020] [Accepted: 04/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND In psoriatic arthritis (PsA), both psoriasis and musculoskeletal manifestations may impair Health-Related Quality of Life (HRQoL). Our objective was to explore the impact of the various disease manifestations and disease consequences, including psychosocial factors, on HRQoL in PsA patients treated in the biologic treatment era. METHODS Data collection in the 131 outpatient clinic PsA patients assessed included demographics, disease activity measures for both skin and musculoskeletal involvement and patient-reported outcome (PRO) measures, treatment and psychosocial burden. The skin dimension of quality of life was assessed by the Dermatology Life Quality Index (DLQI) and the overall HRQoL by the 15-Dimensional (15D) Questionnaire. RESULTS The mean age was 51.9 years, PsA disease duration 8.6 years, 50.4% were men, 56.9% were employed/working and 47.7% had ≥1 comorbidities. Prevalence of monotherapy with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) was 36.6% and with biologic DMARDs 12.2% and combination of both 22.9%. Mean DLQI was 3.3 and 15D 0.84. In adjusted analysis, not employed/working, higher scores for fatigue, sleep disturbances, anxiety and depression, Modified Health Assessment Questionnaire and presence of comorbidities were independently associated with impaired HRQoL (lower 15D scores), whereas Psoriasis Area Severity Index (PASI) and DLQI were not. Younger age and higher Psoriatic Arthritis Disease Activity Score and PASI scores were independently associated with impaired skin quality of life (higher DLQI score). CONCLUSION Our study highlights the negative impact the psychosocial burden, impaired physical function and comorbidities has on reduced HRQoL in PsA outpatients. Thus, to further improve HRQoL in PsA patients, not only physical concerns but also psychological concerns need to be addressed.
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Affiliation(s)
- Glenn Haugeberg
- Division of Rheumatology, Dept. of Medicine, Sorlandet Hospital Kristiansand, Kristiansand, Norway
| | - Brigitte Michelsen
- Department of Rheumatology, Hospital of Southern Norway Trust Kristiansand, Kristiansand, Norway
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Michelsen B, Georgiadis S, Di Giuseppe D, Loft AG, Nissen MJ, Iannone F, Pombo‐Suarez M, Mann H, Rotar Z, Eklund KK, Kvien TK, Santos MJ, Gudbjornsson B, Codreanu C, Yilmaz S, Wallman JK, Brahe CH, Möller B, Favalli EG, Sánchez‐Piedra C, Nekvindova L, Tomsic M, Trokovic N, Kristianslund EK, Santos H, Löve TJ, Ionescu R, Pehlivan Y, Jones GT, van der Horst‐Bruinsma I, Ørnbjerg LM, Østergaard M, Hetland ML. Real‐world 6 and 12‐month Drug Retention, Remission and Response Rates of Secukinumab in 2,017 Psoriatic Arthritis patients in 13 European Countries. Arthritis Care Res (Hoboken) 2021; 74:1205-1218. [DOI: 10.1002/acr.24560] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/18/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Brigitte Michelsen
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Division of Rheumatology Department of Medicine Hospital of Southern Norway Trust Kristiansand Norway
- Department of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway
| | - Stylianos Georgiadis
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
| | - Daniela Di Giuseppe
- Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden
| | - Anne G Loft
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Department of Rheumatology Aarhus University Hospital Aarhus Denmark
| | - Michael J Nissen
- Department of Rheumatology Geneva University Hospital Geneva Switzerland
| | - Florenzo Iannone
- GISEA registry Rheumatology Unit – DETO University of Bari Italy
| | - Manuel Pombo‐Suarez
- Rheumatology Service Hospital Clinico Universitario Santiago de Compostela Spain
| | - Herman Mann
- Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic
| | - Ziga Rotar
- biorx. si Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia
| | - Kari K Eklund
- Inflammation Center Department of Rheumatology Helsinki University Hospital, Helsinki, Finland and ORTON Orthopaedic Hospital of the Orton Foundation Helsinki Finland
| | - Tore K Kvien
- Department of Rheumatology and Research Diakonhjemmet Hospital Oslo Norway
| | - Maria J Santos
- Reuma.pt registry and Instituto de Medicina Molecular Faculdade de Medicina Universidade de Lisboa Lisboa Portugal
| | - Bjorn Gudbjornsson
- Centre for Rheumatology Research (ICEBIO) University Hospital Faculty of Medicine University of Iceland Reykjavik Iceland
| | - Catalin Codreanu
- University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Sema Yilmaz
- Division of Rheumatology Selcuk University School of Medicine Selcuklu, Konya Turkey
| | - Johan K Wallman
- Department of Clinical Sciences Lund Rheumatology Lund University Skåne University Hospital Lund Sweden
| | - Cecilie H Brahe
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
| | - Burkhard Möller
- Universitätsklinik für Rheumatologie Immunologie und Allergologie Inselspital Bern Switzerland
| | - Ennio G Favalli
- Division of Clinical Rheumatology ASST Gaetano Pini‐CTO Institute Milan Italy
| | | | - Lucie Nekvindova
- Institute of Rheumatology and Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic
- Institute of Biostatistics and Analyses, Ltd spinoff company of the Masaryk University Brno Czech Republic
| | - Matija Tomsic
- biorx. si Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia
| | - Nina Trokovic
- Inflammation Center Department of Rheumatology Helsinki University Hospital, Helsinki, Finland and ORTON Orthopaedic Hospital of the Orton Foundation Helsinki Finland
| | | | - Helena Santos
- Reuma.pt registry and Portuguese Institute of Rheumatology Lisbon Portugal
| | - Thorvardur J Löve
- University of Iceland, Faculty of Medicine, and Department of Science and Research, Landspitali University Hospital Reykjavik Iceland
| | - Ruxandra Ionescu
- University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Yavuz Pehlivan
- Rheumatology Department Faculty of Medicine Uludağ University Bursa Turkey
| | - Gareth T Jones
- Epidemiology Group Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen Aberdeen United Kingdom
| | - Irene van der Horst‐Bruinsma
- Amsterdam University Medical Centres location VU University medical centre Department Rheumatology & Immunology Center (ARC) Amsterdam the Netherlands
| | - Lykke M Ørnbjerg
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- DANBIO Registry Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet, Glostrup Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
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Haugeberg G, Hoff M, Kavanaugh A, Michelsen B. Psoriatic arthritis: exploring the occurrence of sleep disturbances, fatigue, and depression and their correlates. Arthritis Res Ther 2020; 22:198. [PMID: 32847612 PMCID: PMC7448431 DOI: 10.1186/s13075-020-02294-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/13/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction Sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) may be influenced by skin and musculoskeletal manifestations. All of these in turn affect the psychosocial impact of disease. The objective was to explore the occurrence of sleep disturbances, fatigue, and anxiety/depression in psoriatic arthritis (PsA) patients, and their correlates. Methods A broad data collection was performed in 137 Norwegian PsA outpatient clinic patients including demographics, disease activity measures for both skin and musculoskeletal involvement, and patient-reported outcome measures. Sleep disturbances and fatigue were defined present if the numeric rating scale (0–10) score was ≥ 5. Anxiety/depression was assessed using a questionnaire (1–3; 1 defined as no anxiety/depression). Descriptive statistics was applied, and associations were explored using univariate and adjusted linear regression analysis. Results The mean age was 52.3 years, PsA disease duration 8.8 years; 49.6% were men and 54.8% were currently employed/working. The prevalence of sleep disturbances was 38.0%, fatigue 44.5%, and anxiety/depression 38.0%. In adjusted analysis, pain, fatigue, and higher mHAQ were associated with sleep disturbances. Sleep disturbances, pain, and anxiety/depression were associated with fatigue, whereas only fatigue was associated with anxiety/depression. Conclusions The prevalence of sleep disturbances, fatigue, and anxiety/depression was frequently reported by PsA patients. No measures reflecting skin involvement or objective measures of musculoskeletal involvement were independently associated with sleep disturbances, fatigue, or anxiety/depression. Our data suggest that patients’ perceptions of musculoskeletal involvement (pain or mHAQ) play an important role causing sleep disturbances and fatigue, whereas fatigue in PsA patients is strongly associated with anxiety/depression.
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Affiliation(s)
- Glenn Haugeberg
- Division of Rheumatology, Department of Medicine, Sorlandet Hospital, P.O.Box 416, N-4604, Kristiansand S, Norway. .,Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Mari Hoff
- Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Brigitte Michelsen
- Division of Rheumatology, Department of Medicine, Sorlandet Hospital, P.O.Box 416, N-4604, Kristiansand S, Norway
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Haugeberg G, Michelsen B, Østensen M, Kavanaugh A. Perceived influence of health status on sexual activity in patients with psoriatic arthritis. Scand J Rheumatol 2020; 49:468-475. [PMID: 32669024 DOI: 10.1080/03009742.2020.1774647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objective: To examine the prevalence of self-reported problems with sexual activity among psoriatic arthritis (PsA) patients, and to explore potential associations of such problems with various demographic, musculoskeletal, and dermatological disease variables. Method: Consecutive PsA patients were recruited from an outpatient clinic. Data collected included demographics, measures of musculoskeletal and skin disease activity, and treatments. Perceived effect of health status on sexual activity was assessed using question number 15 from the health-related quality of life instrument 15D; this was explored in univariate and multivariate logistic regression analyses. Results: The study assessed 135 patients (mean age 52.1 years, disease duration 8.7 years, 51.1% male). Mean scores included Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) 2.9, Disease Activity index for PSoriatic Arthritis (DAPSA) 18.2, patient global assessment (PGA) 36.0 mm, pain 33.7 mm, fatigue 45.1 mm, modified Health Assessment Questionnaire (mHAQ) 0.42, Psoriasis Area Severity Index (PASI) 2.5, and Dermatology Life Quality Index (DLQI) 3.4. Twenty-four patients (17.8%) reported that their health status had a large negative effect and 111 (82.2%) that it had no or little effect on their sexual activity. In univariate analyses, a statistically significant association with impaired sexual activity was found for longer disease duration and higher MASES, DAPSA, PGA, fatigue, and mHAQ scores, but not for demographic variables or variables reflecting skin psoriasis involvement (PASI, DLQI). In adjusted analyses, only PsA disease duration remained independently associated with impaired sexual activity. Conclusion: One in five PsA patients perceived that their health status had a negative impact on sexual activity. Disease duration and measures reflecting musculoskeletal involvement, but not measures reflecting skin psoriasis involvement, appeared to be associated with impaired sexual activity.
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Affiliation(s)
- G Haugeberg
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital , Kristiansand, Norway.,Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology , Trondheim, Norway
| | - B Michelsen
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital , Kristiansand, Norway
| | - M Østensen
- Division of Rheumatology, Department of Medicine, Sørlandet Hospital , Kristiansand, Norway
| | - A Kavanaugh
- Department of Medicine, School of Medicine, University of California , San Diego, CA, USA
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Wervers K, Luime JJ, Tchetverikov I, Gerards AH, Kok MR, Appels CWY, van der Graaff WL, van Groenendael JHLM, Korswagen LA, Veris-van Dieren JJ, Hazes JMW, Vis M. Comparison of disease activity measures in early psoriatic arthritis in usual care. Rheumatology (Oxford) 2020; 58:2251-2259. [PMID: 31211399 PMCID: PMC7032073 DOI: 10.1093/rheumatology/kez215] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 04/23/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives To compare responsiveness and longitudinal validity of Disease Activity Score 28 (DAS28), Disease Activity index for PSoriatic Arthritis (DAPSA), Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic ArthritiS Disease Activity Score (PASDAS), GRAppa Composite scorE (GRACE) and Minimal Disease Activity (MDA) in usual care PsA patients, within 1 year after diagnosis. Methods Data collected in the Dutch southwest early PsA cohort (DEPAR) were used. Responsiveness was assessed using effect size (ES), standardized response mean (SRM), and discrimination between different general health states. Longitudinal validity was tested using mixed models with outcomes health-related quality of life (HRQOL), productivity and disability. Results Responsiveness was highest for PASDAS, with ES 1.00 and SRM 0.95, lowest for DAPSA, with ES 0.73 and SRM 0.71, and in between for DAS28, CPDAI and GRACE. Differences in general health were best discriminated with PASDAS and GRACE. Patients reporting stable or worsening general health could not be distinguished by DAS28 or CPDAI. Discrimination was better using DAPSA, but worse than when using PASDAS and GRACE. Longitudinal evolvement of HRQOL and productivity had the highest association with low disease activity according to GRACE, followed by PASDAS, MDA, DAPSA, DAS28, with the lowest association for CPDAI. Conclusion PASDAS and GRACE were superior with respect to responsiveness, and together with MDA best related to longitudinal evolvement of HRQOL, productivity and disability. Responsiveness and longitudinal validity of most outcomes were inferior for DAS28, DAPSA and CPDAI. As alternatives to the continuous measure DAPSA, use of PASDAS or GRACE should be considered.
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Affiliation(s)
- Kim Wervers
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Ilja Tchetverikov
- Department of Rheumatology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Andreas H Gerards
- Department of Rheumatology, Vlietland Hospital, Schiedam, The Netherlands
| | - Marc R Kok
- Department of Rheumatology, Maasstad Hospital, Rotterdam, The Netherlands
| | | | | | | | - Lindy-Anne Korswagen
- Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands
| | | | - Johanna M W Hazes
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marijn Vis
- Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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Zardin-Moraes M, da Silva ALFA, Saldanha C, Kohem CL, Coates LC, Henrique LR, Palominos PE, Chakr RMDS. Prevalence of Psoriatic Arthritis Patients Achieving Minimal Disease Activity in Real-world Studies and Randomized Clinical Trials: Systematic Review with Metaanalysis. J Rheumatol 2019; 47:839-846. [DOI: 10.3899/jrheum.190677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2019] [Indexed: 01/07/2023]
Abstract
Objective.To estimate the frequency of patients with psoriatic arthritis (PsA) achieving minimal disease activity (MDA) status in real-world studies and randomized controlled trials (RCT).Methods.A systematic literature search for 2009–2017 was performed in PubMed, Embase, Cochrane Library, and LILACS. Study selection and data extraction were performed by 2 independent researchers. Random-effects single-arm metaanalyses were performed and heterogeneity was assessed using I2.Results.A total of 405 records were identified and 45 studies were analyzed: 39 (86.7%) observational studies and 6 (13.3%) RCT; they included 12,469 patients. The overall prevalence of MDA in cross-sectional studies was 35% (95% CI 30%–41%, I2 = 94%), varying from 17% (95% CI 7%–34%) in patients taking synthetic disease-modifying antirheumatic drugs (DMARD) to 57% (95% CI 41%–71%) in those taking biological DMARD. Prevalence of MDA in cohort studies increased with longer followup time, ranging from 25% (95% CI 15%–40%) with 3- to 4-month followup to 42% (95% CI 38%–45%) with > 24-month followup. Patients with PsA receiving biological DMARD in a real-world context and RCT had similar prevalence of MDA at 6-month followup: 30% (95% CI 21%–41%, I2 = 85%) versus 32% (95% CI 26%–39%, I2 = 79%), respectively.Conclusion.Patients with PsA included in real-world studies had similar prevalence of MDA compared to those in controlled clinical trials. This finding suggests that MDA is a useful treatment target for PsA in the real-world setting.
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Wervers K, Vis M, Tchetveriko I, Gerards AH, Kok MR, Appels CWY, van der Graaff WL, van Groenendael JHLM, Korswagen LA, Veris-van Dieren JJ, Hazes JMW, Luime JJ. Burden of Psoriatic Arthritis According to Different Definitions of Disease Activity: Comparing Minimal Disease Activity and the Disease Activity Index for Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2019; 70:1764-1770. [PMID: 29609220 PMCID: PMC6587485 DOI: 10.1002/acr.23571] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 03/27/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Treat-to-target strategies have improved outcomes in rheumatic diseases. In psoriatic arthritis (PsA), the proposed targets are the multidimensional target minimal disease activity (MDA) and the articular target Disease Activity index for PsA (DAPSA). The aim of this study was to compare the disease burden of PsA in patients with low disease activity according to the 2 definitions, MDA and DAPSA low disease activity (DAPSA-LDA), 1 year after diagnosis. METHODS We obtained data on MDA, DAPSA-LDA and disease burden 1 year after diagnosis for patients included in the Dutch southwest early PsA cohort. Disease burden was assessed in 2 domains: "Body functions," including the Short Form 36 bodily pain (SF-36 BP) measure, and "Activity," including the Health Assessment Questionnaire (HAQ). RESULTS Among the 292 patients included, 48% achieved MDA and 74% achieved DAPSA-LDA. Average scores for Body functions and Activity were better in patients who achieved MDA and those who achieved DAPSA-LDA. The scores were significantly better in the 46% of patients who achieved both MDA and DAPSA-LDA than in the 29% of patients who achieved only DAPSA-LDA. The average SF-36 BP score was higher in patients achieving both targets (73.8; 95% confidence interval [95% CI] 71.1-76.5) than in patients achieving only DAPSA-LDA (57.6; 95% CI 54.5-60.8). Similarly, mean HAQ scores measuring Activity were 0.21 (95% CI 0.15-0.26) and 0.63 (95% CI 0.53-0.72), respectively. CONCLUSION Among patients with newly diagnosed PsA, 48% achieved MDA and 74% achieved DAPSA-LDA after 1 year of receiving usual care. The average disease burden was better in patients who achieved MDA and those who achieved DAPSA-LDA. Also, patients who achieved only DAPSA-LDA reported worse outcomes than those who also achieved MDA.
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Affiliation(s)
- Kim Wervers
- Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marijn Vis
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Marc R Kok
- Maasstad Hospital, Rotterdam, The Netherlands
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Pontifex EK, Dissanayake K, Bursill D, Gill T. Prevalence of minimal disease activity in Australian patients with Psoriatic Arthritis: Assessing the outcome of national funding criteria for biologic disease-modifying antirheumatic drug prescribing. Int J Rheum Dis 2018; 22:262-268. [PMID: 30450819 DOI: 10.1111/1756-185x.13441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 01/05/2023]
Abstract
AIM Discrepancies exist between international treatment guidelines and current Australian Pharmaceutical Benefits Scheme (PBS) criteria for funding biologic disease-modifying antirheumatic drug (bDMARD) prescribing in psoriatic arthritis (PsA). We aimed to determine the prevalence of minimal disease activity (MDA) achievement and differences in inflammatory marker levels between PsA patients who have and have not met the Australian PBS criteria for bDMARDs. METHOD Consecutive participants diagnosed with PsA were assessed for MDA components and serum inflammatory markers. For those on bDMARDs, joint counts and inflammatory markers at the time of bDMARD qualification were compared with matched rheumatoid arthritis (RA) controls. RESULTS Minimal disease activity was achieved by 56/105 participants overall. There were no differences in inflammatory marker levels or involved joint count patterns between the PsA and RA groups at the time of bDMARD qualification. Seventy-three percent of the 53 PsA patients on bDMARD achieved MDA, vs 33% in the non-bDMARD group (P < 0.001). More bDMARD than non-bDMARD patients achieved four out of seven MDA components. Of those with any enthesitis, its prevalence was higher in the non-bDMARD group (22 vs 10, P = 0.009). Regardless of treatment, there was no difference in inflammatory marker levels between those who did and did not achieve MDA. CONCLUSION The Australian PBS criteria, funding bDMARD prescribing for PsA, select well for MDA achievers. A high prevalence of MDA non-achievement remains in patients ineligible for bDMARD funding, and enthesitis in this population is more common. Inflammatory markers were not discriminators between treatment or MDA achievement groups.
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Affiliation(s)
- Eliza K Pontifex
- Department of Rheumatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Kokum Dissanayake
- Department of Rheumatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - David Bursill
- Department of Rheumatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Tiffany Gill
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
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Haugeberg G, Michelsen B, Tengesdal S, Hansen IJW, Diamantopoulos A, Kavanaugh A. Ten years of follow-up data in psoriatic arthritis: results based on standardized monitoring of patients in an ordinary outpatient clinic in southern Norway. Arthritis Res Ther 2018; 20:160. [PMID: 30071892 PMCID: PMC6090981 DOI: 10.1186/s13075-018-1659-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/04/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Over the last decade, a treat-to-target (T2T) strategy has been recommended for psoriatic arthritis (PsA) and new treatment options have become available. There is a lack of data on PsA regarding any changes that may have occurred over these past years. Thus, the main aim of this study was to look for changes in clinical disease status and treatment in a PsA outpatient clinic population monitored over the period 2008 to 2017. METHODS Annual data collection included demographic data, laboratory (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and clinic measures of disease activity (e.g., 28 and 32 joint count Disease Activity Score (DAS28), Clinical Disease Activity Index (CDAI), and modified Disease Activity index for Psoriatic arthritis (DAPSA)), evaluator's global assessment, and patient-reported outcomes (PROs), including for example measures of physical function, pain, and patient global assessment. Disease-modifying antirheumatic drug (DMARD) use was also registered. RESULTS In the PsA outpatient clinic population over the 10-year period (annual mean number of patients, 331) the mean (standard deviation) age was 58.4 (12.4) years, disease duration was 9.6 (7.9) years, 49.4% were female, and 17.6% were current smokers. From 2008 to 2017, no statistically significant increase in remission rates was seen for DAPSA (13.5% and 22.0%) or Boolean remission (6.6% and 8.9%), whereas a statistically significant increase was seen for DAS28-ESR (36.8% and 50.6%) and CDAI (20.0% and 29.6%), but not for the last 5 years (DAS28-ESR, 42.3% and 50.6%; CDAI, 27.9% and 29.6%). Furthermore, over the 10-year period no significant improvement for PROs and no significant change in the use of synthetic (annual mean 53.0%) and biologic DMARDs (annual mean 29.9%) was found. CONCLUSION Our data suggest that even in the biologic treatment era there is an unmet need for treating PsA patients to target remission. New treatment options and the development of more feasible and valid outcome measures for use in a T2T strategy in ordinary clinical practice may in the future to further improve clinical outcomes in PsA.
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Affiliation(s)
- Glenn Haugeberg
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Servicebox 416, 4604 Kristiansand, Norway
- Department of Neuroscience, Division of Rheumatology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Brigitte Michelsen
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Servicebox 416, 4604 Kristiansand, Norway
| | - Stig Tengesdal
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Servicebox 416, 4604 Kristiansand, Norway
| | - Inger Johanne Widding Hansen
- Division of Rheumatology, Department of Medicine, Hospital of Southern Norway Trust, Servicebox 416, 4604 Kristiansand, Norway
| | | | - Arthur Kavanaugh
- Division of Rheumatology, Allergy, and Immunology, School of Medicine, University of California, San Diego, USA
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Queiro R, Coto-Segura P. Ustekinumab in psoriatic arthritis: need for studies from real-world evidence. Expert Opin Biol Ther 2018; 18:931-935. [DOI: 10.1080/14712598.2018.1504919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Rubén Queiro
- Rheumatology Division, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
| | - Pablo Coto-Segura
- Dermatology Division, Hospital Alvarez Buylla, Mieres, Asturias, Spain
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Gulati AM, Michelsen B, Diamantopoulos A, Grandaunet B, Salvesen Ø, Kavanaugh A, Hoff M, Haugeberg G. Osteoporosis in psoriatic arthritis: a cross-sectional study of an outpatient clinic population. RMD Open 2018; 4:e000631. [PMID: 30018797 PMCID: PMC6045713 DOI: 10.1136/rmdopen-2017-000631] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 01/21/2023] Open
Abstract
Background The risk of osteoporosis in patients with psoriatic arthritis (PsA) still remains unclear. The aim of this study was to investigate bone mineral density (BMD) at the hip and lumbar spine measured by dual-energy X-ray absorptiometry in patients with PsA. Methods From an outpatient clinic in southern Norway, 140 patients with PsA were consecutively recruited and assessed for osteoporosis as part of a prospective study from January 2013 to May 2014. An extensive data collection was performed including demographic data and measures reflecting disease activity and health status. Results Mean age was 52.4 years and 71 (50.7%) were women. Median disease duration was 7.8 years. The proportion of patients with low BMD (defined as Z score≤-1.0 SD) was comparable to the expected value of 16%, according to the normal distribution of the Z score in the population. Osteoporosis was only found in 6.4% (95% CI3% to 11%) of the patients. No significant associations were found between BMD and disease activity measures. Conclusion The prevalence of PsA patients with osteoporosis or low BMD was low and in the range seen in the reference population. This supports that patients with PsA are not at high risk for osteoporosis compared with the general population. Therefore, clinicians may follow the general population guidelines for monitoring of osteoporosis for patients with PsA.
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Affiliation(s)
- Agnete Malm Gulati
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Brigitte Michelsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand, Norway
| | | | - Berit Grandaunet
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arthur Kavanaugh
- Department of Rheumatology, Allergy and Immunology, University of California San Diego, San Diego, California, USA
| | - Mari Hoff
- Department of Rheumatology, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Glenn Haugeberg
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Rheumatology, Martina Hansens Hospital, Bærum, Norway
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van Mens LJJ, van de Sande MGH, Fluri IA, Atiqi S, van Kuijk AWR, Baeten DLP. Residual disease activity and treatment adjustments in psoriatic arthritis in current clinical practice. Arthritis Res Ther 2017; 19:226. [PMID: 29017591 PMCID: PMC5634872 DOI: 10.1186/s13075-017-1424-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/06/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND With expanding therapeutic possibilities for treatment of psoriatic arthritis (PsA) it will be increasingly important to determine residual disease and define when to adjust treatment. The rationale behind treatment decisions in current daily clinical practice and the relationship with residual disease activity has not been investigated. The aim of this study was to assess current clinical practice on defining residual disease and subsequent treatment decisions made in PsA patients. METHODS This cross-sectional study scored disease activity and treatment decisions prospectively in 142 consecutive PsA patients visiting the outpatient clinic for routine follow up. Disease activity parameters were scored by patient and the treating rheumatologist; the rheumatologist additionally registered his opinion on the presence of remaining disease activity despite current treatment (further mentioned as remaining disease) and subsequent treatment decisions. RESULTS Two thirds (90/142) of patients had remaining disease activity according to the treating rheumatologist. Almost half (46%) of these patients had moderate to high disease activity according to the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA). Residual disease activity was determined by joint disease and pain rather than by active psoriasis. Demographic and clinical features were similar between groups with or without residual disease. Among patients with remaining disease activity, 74% were treated with either a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) only or a first TNF-inhibiting biological agent, suggesting opportunities for treatment modification. However, treatment adjustment was initiated in only 21 (23%) of the 90 patients with residual disease. When comparing patients with remaining disease activity with and without treatment adjustment, we found no differences in objective disease activity measures, such as joint counts and patient scores. These data suggest that treatment is not adjusted in a large majority of patients with residual disease activity, although options for treatment changes are available. CONCLUSIONS Remaining disease activity is present in almost two thirds of patients with PsA when scored by the treating rheumatologist, but triggers treatment adjustment in only a minority. Further research to understand why disease activity does not lead to treatment adjustment is required to enable implementation of treatment strategies in clinical practice.
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Affiliation(s)
- Leonieke J. J. van Mens
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Marleen G. H. van de Sande
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Inka A. Fluri
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sadaf Atiqi
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Arno W. R. van Kuijk
- Rheumatology, Amsterdam Rheumatology and immunology Center | Reade, Amsterdam, The Netherlands
| | - Dominique L. P. Baeten
- Department of Clinical Immunology & Rheumatology, Amsterdam Rheumatology and immunology Center, Academic Medical Center/University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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