Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Psoriatic arthritis (PsA) often occurs with skin psoriasis (PsO). Disease activity can be measured using several tools including Minimal Disease Activity (MDA/VLMDA) or 28 joint disease activity (DAS28). The Psoriasis Area and Severity Index (PASI) assess the severity of PsO. Patient reported outcome measures (PROMs) are increasingly accepted as key outcome measures (new OMERACT guidelines) including the Dermatology Quality of Life Index (DLQI) and EuroQol 5 dimensions questionnaire (EQ-5D). Our objective was to compare PROMs in MDA and DAS28 disease states, including severe psoriasis, defined as PASI >10 or DLQI>10 or Body Surface Area >10.
Methods:
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), in a IRB approved cross-sectional analysis. Statistics were performed using SPSS Version 23.
Results:
129 sequential patients attending between February and November 2016 were included. Population characteristics are outlined in Table 1. 82% of patients had psoriasis, with a DLQI score available for 88% (n=93). MDA and DAS28 low disease activity identified similar patients, with similar arthritis outcomes, generally better in MDA (Tables 1 and 2). Our population generally did not have high PASI (mean 1.38). 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 fewer with DLQI >10 (3%).
Conclusion:
MDA and DAS28 measures identify patients with similar arthritis outcomes. Patients in MDA and low DAS28 states have lower DLQI values. MDA is associated with significantly fewer patients with high DLQI. This suggests that MDA identifies patients who have a better overall psoriatic disease outcome.
Table 1: Patient Characteristics, MDA and Very Low (VL)-MDA
|
Characteristics |
VL-MDA N=19 |
MDA N=46 |
Not-MDA N=83 |
P Value |
|
Age years |
51 (19.4) |
47 (13.44) |
52 (14.15) |
0.92 * |
|
Gender (%F) |
32% (6/19) |
33% (15/46) |
36% (30/83) |
0.686** |
|
Mean DAS28 |
1.6(0.46) |
1.86 (0.54) |
3.88 (1.25) |
|
|
DAS28 remission |
100% (19/19) |
91%(42/46) |
12%(10/83) |
<0.0001 ** |
|
DAS28 2.6-3.2 |
0 |
4% (2/46) |
17%(14/83) |
0.388** |
|
DAS28 3.2-5.1 |
0 |
0 |
53% (44/83) |
|
|
DAS28 >5.1 |
0 |
0 |
18% (15/83) |
|
|
EQ5D Utility Index |
0.86 |
0.78 |
0.45 |
<0.0005 * |
|
EQ5D VAS |
84 |
79 |
50 |
<0.0005 * |
|
PASI>10 |
0 |
0 |
5 |
0.222** |
|
DLQI >10 |
0 |
3% (1/36) |
34% (20/59) |
0.001** |
|
HAQ-DI |
0.0789 |
0.22 |
1.32 |
<0.0005 * |
|
VAS Pain (0-100) |
15 |
25 |
63 |
<0.0005 * |
P Value calculated comparing MDA and not-MDA groups using:*Mann Whitney U test; ** Chi Squared test
Table 2: MDA and QoL measures compared to DAS28 scores
|
Total number 127 |
DAS remission N= 50 |
DAS 2.6-3.2 N=17 |
DAS 3.2-5.1 N= 45 |
DAS>5.1 N= 15 |
P Value |
|
PsO |
40/50 (80%) |
15/17 (88%) |
37/45(82%) |
12/15(80%) |
1.00** |
|
MDA |
80% (40/50) |
18% (3/17) |
2% (1/45) |
0 |
0.000** |
|
HAQ-DI |
0.432 |
0.583 |
1.49 |
1.86 |
0.000* |
|
EQ5D Utility Index |
0.77 |
0.687 |
0.53 |
0.138 |
0.000* |
|
EQ5D VAS |
70 |
71 |
53.4 |
36 |
0.000* |
|
VAS Pain 0-100 |
29 |
55 |
60 |
81 |
0.000* |
|
PASI >10 |
1/50 (2%) |
0 |
3/45 (7%) |
1/15 (7%) |
0.662** |
|
DLQI >10 |
4/38 (11%) |
3/13(23%) |
8/32 (25%) |
5/10 (50%) |
0.033** |
|
DLQI 5-10 |
8/38 (21%) |
1/13 (8%) |
8/32 (25%) |
3/10 (30%) |
|
|
DLQI <5 |
26/38(68%) |
9/13(69%) |
16/32(50%) |
2/10 (20%) |
P Value calculated comparing DAS28 remission and non DAS28 remission groups using: *Mann Whitney U; **chi squared test
To cite this abstract in AMA style:
Hughes C, Ng N, Garrood T, Kirkham B. Comparison of Quality-of-Life, Function and Psoriasis Measures in Minimal Disease Activity and DAS28 States in Routine Care of Patients with Psoriatic Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/comparison-of-quality-of-life-function-and-psoriasis-measures-in-minimal-disease-activity-and-das28-states-in-routine-care-of-patients-with-psoriatic-arthritis/. Accessed .« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/comparison-of-quality-of-life-function-and-psoriasis-measures-in-minimal-disease-activity-and-das28-states-in-routine-care-of-patients-with-psoriatic-arthritis/