Background/Purpose: Minimal disease activity (MDA) is now considered an objective target which is more attainable in psoriatic arthritis (PsA) compared to remission (DAS28 <2.6) which is more difficult to achieve and maintain. The criteria for MDA encompass different aspects of this distinct and heterogeneous disease. The aim of this analysis was to assess which unmet criteria were more common among patients who achieved MDA based on patient reported outcomes (PROs) in a real-world, routine clinical care setting in Canada.

Methods:  BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with infliximab (IFX) or golimumab (GLM). Eligible patients for this analysis included PsA patients treated with IFX or GLM between 2005 and 2015. MDA was defined as the fulfillment of ≥5 of the following criteria: TJC28≤1, SJC28≤1, PASI≤1, pain (VAS) ≤15 mm, PtGA (VAS) ≤20 mm, HAQ≤0.5, tender entheseal points ≤1.

Results: A total of 223 PsA patients (51.4% male) were included with a mean (SD) age of 49.8 (11.1) years and disease duration since diagnosis of 5.4 (6.3) years. MDA was achieved by 11.7%, 43.5%, and 44.8% at baseline, 6 months and 12 months of treatment, respectively. The most commonly unmet MDA criteria in patients who achieved 5/7 criteria was patient-reported pain (69.2%), PtGA (48.7%), and HAQ (20.5%). The mean (SD) for these disease parameters were 31.8 (13.5) mm for pain, 39.3 (10.9) mm for PtGA and 0.95 (0.46) for HAQ. Furthermore, in these patients the most prevalent combination in unmet criteria was pain+PtGA with 38.5% followed by PASI+pain with 12.8%. In patients who achieved 6/7 MDA criteria, the most commonly unmet criteria included PASI with 21.9%, pain with 18.8% and HAQ with 18.8%. The mean (SD) for these disease parameters were 3.7 (2.1) for PASI, 22.8 (7.9) mm for pain and 0.75 (0.08) for HAQ.

Conclusion: The current analysis has shown that by 6 months of treatment almost 50% of patients achieved MDA. Among patients who achieved 5/7 criteria the most commonly unmet criteria in patients who achieved MDA are PROs including pain, PtGA and HAQ-DI. These results highlight the difference in the perception of disease activity by physicians and patients and in the relative importance placed on specific disease aspects.

« Back to 2016 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/minimal-disease-activity-among-psoriatic-arthritis-patients-in-canada-which-unmet-criteria-are-more-prevalent-among-responders/