Residual disease activity in psoriatic arthritis: discordance between the rheumatologist's opinion and minimal disease activity measurement

Leonieke J J van Mens, Maureen C Turina, Marleen G H van de Sande, Mike T Nurmohamed, Arno W R van Kuijk, Dominique L P Baeten

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objective: To assess how many PsA patients with an acceptable disease state according to the treating rheumatologist have quiescent disease defined as minimal disease activity (MDA).

Methods: This cross-sectional study included 250 PsA patients. To assess current clinical practice as closely as possible, acceptable disease state was not determined by predefined activity measures, but instead was defined by asking rheumatologists to refer those patients whom they considered sufficiently treated. Patients were evaluated for current disease activity including clinical assessments and patient reported outcomes (PROs).

Results: One-third (88/250) of the patients with acceptable disease state according to the rheumatologist did not fulfil MDA (MDA-). The presence of tender joints and patient pain and global disease activity scores most frequently contributed to not fulfilling MDA (not achieved in 83, 82 and 80%, respectively). However, also objective signs of disease activity were higher in the MDA- than MDA+ patient group: a swollen joint count >1 occurred in 35% vs 7% (P < 0.001), enthesitis >1 in 14% vs 3% (P = 0.002) and Psoriasis Area and Severity Index >1 in 43% vs 26% (P = 0.002). Residual disease was more frequent in females, elder patients and those with a raised BMI, independent of the treatment schedule, and negatively influenced PROs of function and quality of life.

Conclusion: One-third of the PsA patients with acceptable disease state according to the treating rheumatologist did not fulfil the MDA criteria and had residual disease activity on both subjective and objective disease activity measurements. As residual disease activity was associated with worse PROs, future strategy trials should evaluate if treatment adjustments are beneficial for this patient group.

Original languageEnglish
Pages (from-to)283-290
Number of pages8
JournalRheumatology (Oxford, England)
Volume57
Issue number2
DOIs
Publication statusPublished - 1 Feb 2018

Cite this

@article{31f9984a0797425987dba24ef1bb2431,
title = "Residual disease activity in psoriatic arthritis: discordance between the rheumatologist's opinion and minimal disease activity measurement",
abstract = "Objective: To assess how many PsA patients with an acceptable disease state according to the treating rheumatologist have quiescent disease defined as minimal disease activity (MDA).Methods: This cross-sectional study included 250 PsA patients. To assess current clinical practice as closely as possible, acceptable disease state was not determined by predefined activity measures, but instead was defined by asking rheumatologists to refer those patients whom they considered sufficiently treated. Patients were evaluated for current disease activity including clinical assessments and patient reported outcomes (PROs).Results: One-third (88/250) of the patients with acceptable disease state according to the rheumatologist did not fulfil MDA (MDA-). The presence of tender joints and patient pain and global disease activity scores most frequently contributed to not fulfilling MDA (not achieved in 83, 82 and 80{\%}, respectively). However, also objective signs of disease activity were higher in the MDA- than MDA+ patient group: a swollen joint count >1 occurred in 35{\%} vs 7{\%} (P < 0.001), enthesitis >1 in 14{\%} vs 3{\%} (P = 0.002) and Psoriasis Area and Severity Index >1 in 43{\%} vs 26{\%} (P = 0.002). Residual disease was more frequent in females, elder patients and those with a raised BMI, independent of the treatment schedule, and negatively influenced PROs of function and quality of life.Conclusion: One-third of the PsA patients with acceptable disease state according to the treating rheumatologist did not fulfil the MDA criteria and had residual disease activity on both subjective and objective disease activity measurements. As residual disease activity was associated with worse PROs, future strategy trials should evaluate if treatment adjustments are beneficial for this patient group.",
keywords = "Journal Article",
author = "{van Mens}, {Leonieke J J} and Turina, {Maureen C} and {van de Sande}, {Marleen G H} and Nurmohamed, {Mike T} and {van Kuijk}, {Arno W R} and Baeten, {Dominique L P}",
year = "2018",
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Residual disease activity in psoriatic arthritis : discordance between the rheumatologist's opinion and minimal disease activity measurement. / van Mens, Leonieke J J; Turina, Maureen C; van de Sande, Marleen G H; Nurmohamed, Mike T; van Kuijk, Arno W R; Baeten, Dominique L P.

In: Rheumatology (Oxford, England), Vol. 57, No. 2, 01.02.2018, p. 283-290.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Residual disease activity in psoriatic arthritis

T2 - discordance between the rheumatologist's opinion and minimal disease activity measurement

AU - van Mens, Leonieke J J

AU - Turina, Maureen C

AU - van de Sande, Marleen G H

AU - Nurmohamed, Mike T

AU - van Kuijk, Arno W R

AU - Baeten, Dominique L P

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objective: To assess how many PsA patients with an acceptable disease state according to the treating rheumatologist have quiescent disease defined as minimal disease activity (MDA).Methods: This cross-sectional study included 250 PsA patients. To assess current clinical practice as closely as possible, acceptable disease state was not determined by predefined activity measures, but instead was defined by asking rheumatologists to refer those patients whom they considered sufficiently treated. Patients were evaluated for current disease activity including clinical assessments and patient reported outcomes (PROs).Results: One-third (88/250) of the patients with acceptable disease state according to the rheumatologist did not fulfil MDA (MDA-). The presence of tender joints and patient pain and global disease activity scores most frequently contributed to not fulfilling MDA (not achieved in 83, 82 and 80%, respectively). However, also objective signs of disease activity were higher in the MDA- than MDA+ patient group: a swollen joint count >1 occurred in 35% vs 7% (P < 0.001), enthesitis >1 in 14% vs 3% (P = 0.002) and Psoriasis Area and Severity Index >1 in 43% vs 26% (P = 0.002). Residual disease was more frequent in females, elder patients and those with a raised BMI, independent of the treatment schedule, and negatively influenced PROs of function and quality of life.Conclusion: One-third of the PsA patients with acceptable disease state according to the treating rheumatologist did not fulfil the MDA criteria and had residual disease activity on both subjective and objective disease activity measurements. As residual disease activity was associated with worse PROs, future strategy trials should evaluate if treatment adjustments are beneficial for this patient group.

AB - Objective: To assess how many PsA patients with an acceptable disease state according to the treating rheumatologist have quiescent disease defined as minimal disease activity (MDA).Methods: This cross-sectional study included 250 PsA patients. To assess current clinical practice as closely as possible, acceptable disease state was not determined by predefined activity measures, but instead was defined by asking rheumatologists to refer those patients whom they considered sufficiently treated. Patients were evaluated for current disease activity including clinical assessments and patient reported outcomes (PROs).Results: One-third (88/250) of the patients with acceptable disease state according to the rheumatologist did not fulfil MDA (MDA-). The presence of tender joints and patient pain and global disease activity scores most frequently contributed to not fulfilling MDA (not achieved in 83, 82 and 80%, respectively). However, also objective signs of disease activity were higher in the MDA- than MDA+ patient group: a swollen joint count >1 occurred in 35% vs 7% (P < 0.001), enthesitis >1 in 14% vs 3% (P = 0.002) and Psoriasis Area and Severity Index >1 in 43% vs 26% (P = 0.002). Residual disease was more frequent in females, elder patients and those with a raised BMI, independent of the treatment schedule, and negatively influenced PROs of function and quality of life.Conclusion: One-third of the PsA patients with acceptable disease state according to the treating rheumatologist did not fulfil the MDA criteria and had residual disease activity on both subjective and objective disease activity measurements. As residual disease activity was associated with worse PROs, future strategy trials should evaluate if treatment adjustments are beneficial for this patient group.

KW - Journal Article

U2 - 10.1093/rheumatology/kex183

DO - 10.1093/rheumatology/kex183

M3 - Article

VL - 57

SP - 283

EP - 290

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 2

ER -