Background/Purpose:

Psoriatic Arthritis (PsA) is a chronic immune-mediated condition with multiple manifestations; joint inflammation with subsequent joint damage is a key component. Across a number of immunological conditions a high level of patient satisfaction is reported, despite patients having ongoing disease activity.

The objective is to describe and compare the characteristics of PsA patients with active joint disease who are satisfied with their current PsA treatment against those who are unsatisfied.

Methods:

Data were extracted from the Adelphi 2011 / 2014 Rheumatology Disease Specific Programmes, two ‘Real World’ surveys of US rheumatologists and their PsA patients. Selected rheumatologists who make treatment decisions for PsA patients were recruited. Rheumatologists provided patient demographics, PsA disease characteristics and comorbidities. Patients reported their satisfaction with current control of their PsA, and impairment via the Work Productivity Activity Impairment (WPAI) and alternative HAQ-DI (excluding aids and devices) questionnaires.  

Descriptive statistics including means and frequencies were derived for the population with active joint disease (defined as more than 3 tender joints) and stratified by patient satisfaction with PsA treatment (satisfied or dissatisfied).

 Results:

From the database, 78 patients were identified with active joint disease and patient satisfaction reported. 54 (69.2%) patients were satisfied with the treatment of their PsA and the remaining 24 (30.8%) dissatisfied. Compared with dissatisfied patients with active joint disease, satisfied patients tended to be older (53.5 vs. 44.3 years), of male gender (59.3% vs. 50.0%), had a longer duration since PsA diagnosis (6.5 years vs. 3.6) and more likely receiving a biologic DMARD (bDMARD) therapy (64.8% vs. 56.5%). The level of disease activity in the joints was similar in satisfied and dissatisfied patients (mean tender joints: 7.9 vs 7.8; swollen joints: 5.1 vs. 5.0) but the extent of skin involvement was lower in satisfied patients (BSA >3%: 71.4% vs. 82.6%). Overall among patients with active joint disease the most common concomitant conditions were hypertension (30.8%), obesity (25.6%), depression (23.1%), elevated cholesterol (21.8%), diabetes (20.5%), and anxiety (19.2%). Dissatisfied patients had more comorbidities overall (2.2 vs. 1.6) and in particular a greater proportion of dissatisfied patients had depression (33.3% vs. 18.5%) and anxiety (33.3% vs. 13.0%) and were less impaired by their PsA (mean % WPAI activity impairment: 38.5% vs. 47.9%; mean alternative HAQ-DI: 0.657 vs. 0.761).

Conclusion:

These findings add further evidence that even when patients have active joint disease they may still report being satisfied, and suggests that with longer disease duration or prescription of bDMARD therapy, physicians and patients may settle for sub-optimal control of the joint aspects of PsA particularly in relation to joint involvement. These findings serve as a signal that there are challenges to managing PsA appropriately as patients progress in their disease, although further investigation and validation in a larger sample is needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/satisfaction-in-psoriatic-arthritis-patients-despite-active-joint-disease/