Background/Purpose: Depression, a common comorbidity in patients with psoriasis (PsO) and PsA, has been shown to be independently associated with Psoriatic Arthritis Impact of Disease (PsAID-12) scores. We investigated how much active PsO and a positive 2-item Patient Health Questionnaire (PHQ-2) depression screen impacted PsAID-12 scores in patients with PsA in the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) survey.

Methods: UPLIFT was a multinational Web-based survey conducted in 2020 in adults who reported ever being diagnosed by a healthcare provider (HCP) with PsA and/or PsO. For patients with PsA, we report PsAID-12 total and domain scores and Patient Acceptable Symptom State (PASS) achievement (PsAID-12 ≤4) according to the presence of active PsO and depression status. A PHQ-2 score ≥3 indicates a positive screen for depression.

Results: Of the 3,806 patient survey respondents, 1,256 reported HCP-diagnosed PsA, of which 1,064 had HCP-diagnosed PsA + active PsO and 192 had PsA only. In patients with PsA + PsO, enthesitis (44.5%), dactylitis (47.0%), and polyarthritis (59.8%) were more prevalent than in patients with PsA without active PsO (37.5%, 37.5%, and 36.5%, respectively). More patients with PsA + PsO vs PsA only had a history of patient-reported HCP-diagnosed comorbidities, including depression (42.7% vs 26.6%), cancer (30.7% vs 21.4%), heart disease (23.1% vs 13.5%), hypertension (44.0% vs 33.3%), liver disease (21.0% vs 12.5%), and inflammatory bowel disease (25.5% vs 14.1%). Despite differences in comorbidity burden, mean total PsAID-12 scores (Figure 1) and rates of PASS achievement (25.0% vs 26.9%) were similar in patients with PsA only and PsA + PsO. Mean individual PsAID-12 domain scores were generally similar between groups; however, impact of “skin problems” and “embarrassment and/or shame” was more pronounced for the PsA + PsO group (Figure 1). A total of 67% of PsA only and 66% PsA + PsO patients had a PHQ-2 ≥3. Patients with PHQ-2 ≥3 had higher PsAID-12 scores, indicating worse health status, regardless of whether they had active PsO. Fewer patients with PHQ-2 ≥3 achieved PASS (PsA: 10.9%, PsA + PsO: 10.7%) compared with those who screened negative for depression (PsA: 53.1%, PsA + PsO 58.8%). Similarly, higher PsAID-12 domain scores were reported in patients with PsA with PHQ-2 ≥3 vs those with PHQ-2 ≤2 (Figure 2) and to a greater extent in those with PsA + PsO (Figure 3). The greatest differences between groups were observed in domains of “work and/or leisure activities,” “coping,” “anxiety, fear, and uncertainty,” “embarrassment and/or shame,” and “social participation.”

Conclusion: For patients with PsA in UPLIFT, active PsO was associated with generally more active disease and a higher prevalence of comorbidities, including depression. Having a positive PHQ-2 screen for depression was associated with overall disease impact as measured by PsAID.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-impact-of-skin-involvement-and-depression-on-patient-acceptable-symptom-state-in-patients-with-psoriatic-arthritis-and-psoriasis-results-from-a-multinational-survey/