Comparison of Quality-of-Life, Function and Psoriasis measures in Minimal Disease Activity and DAS28 states in routine care of patients with Psoriatic Arthritis
Catherine Hughes, Nora Ng, Toby Garrood, Bruce Kirkham
Rheumatology Department, Guy’s and St Thomas' NHS Foundation Trust, London, UK
Psoriatic arthritis (PsA) is a chronic inflammatory arthritis with a varied clinical phenotype characterized by multiple disease components
•Psoriasis including nail changes.
Improving Quality-of-Life is increasingly accepted as an important goal of treatment.
PsA disease activity can be measured using several tools including Minimal Disease Activity (MDA) or the 28 joint count disease activity score (DAS28) borrowed from Rheumatoid Arthritis. The Psoriasis Area and Severity Index (PASI) is used to assess the severity of Psoriasis. Patient Reported Outcome Measures (PROMs) allow a unique insight into the patient’s perception of disease activity and remission. The importance of these measures has recently been highlighted, resulting in their inclusion in the PsA Core Domain Set .
•Dermatology Quality of Life Index (DLQI)
•EuroQol 5 dimensions questionnaire (EQ-5D).
The objective of this study was to compare PROMs in MDA and DAS28 disease states, including severe psoriasis, defined as
•Body Surface Area >10.
Patients with PsA attending our center completed PROMs and had clinician assessment. The following data was recorded: age, diagnosis, MDA components, DAS28 components, PASI, DLQI, EQ-5D-3L and Health Assessment Questionnaire (HAQ-DI). An ethics approved cross-sectional analysis was used. Statistics were performed using SPSS Version 23.
129 sequential patients attending the department between February and November 2016 were included in this analysis. Population characteristics are outlined in Table 1. 82% (N=106) of patients had psoriasis, with a DLQI score available for 88% (N=93). In the patients who met MDA criteria, 20% had an EQ5D of 1 indicating perfect health, and 39% had a HAQ score of 0. In contrast in those who met DAS28 remission, 16% had an EQ5D of 1 and 32% had a HAQ score of 0. The EQ-5D and HAQ-DI results for the group assessed by MDA are shown in Table 1, and by DAS28 states are shown in Table 2, data are shown as mean (SD).DLQI scores were higher in active PsA. The DAS28 remission group had 11% of patients with a DLQI >10. In contrast the MDA group had only 3% of patients with DLQI >10
Our study found that MDA and DAS28 measures identify patients with similar arthritis outcomes.Patients in MDA and low DAS28 states have lower DLQI values and better EQ5D and HAQ scores .
These results suggest that MDA identifies patients who have a better overall PsA disease outcome.