Background/Purpose:

Despite the availability of more targeted therapies for psoriatic arthritis (PsA), an assessment of the impact these have had on patient well-being has not recently been undertaken.  We investigated a real world perspective on patient  disability, quality of life (QoL), and patient encounters with various health care providers (HCP).

Methods:

A cross sectional analysis of data were derived from a 52-question survey on the effect of PsA on the QoL, daily activities, work, patient satisfaction with treatment and physician care was included. The survey was distributed by the National Psoriasis Foundation (NPF) to its members with a prior diagnosis of PsA by a HCP. The survey was developed using validated questionnaires (PDRQ-9, PASE and HAQ20) and also collected information on PsA disease severity and treatment .

Results:

773 survey responses were collected after distribution to 9,336 NPF members (6.7% response rate); 144 responses were removed due to incomplete data. Based on the epidemiologic features of PsA from the medical literature, this survey of 629 PsA patients was representative of other patients with this disease in the US (margin of error, 3.9%)The average age at diagnosis was 41.7±13 years.  Comorbidities, PASE and HAQ20 scores for patients in the survey were consistent with those reported in the medical literature.  The average HAQ20 disability index score, 0.98±0.66 (Maximum score = 3, highest level of disability) reflects a moderate to severe level of disability. Higher HAQ20 and PASE scores were associated with higher disability, pain and worse overall status.  Overall (scale of 0 –very well to 100 –very poor), patients averaged 43.6±28.2 with females statistically worse than males.  A majority of patients (61.7%) reported that they were unable to work some days due to their health.  A mean of 66.6±104.5 work days (median 15) were missed in the last year; 89.4% of days missed resulted from joint/pain problems.

The most common HCP was a rheumatologist (35.5%; n=223); the proportion of patients treated only by a dermatologist or only by a PCP was 12% (n=76) for each. The PDRQ-9 satisfaction rating for a rheumatologist (36.8) was 22% higher (P≤0.001) than the rating for a PCP (30.1) but not different from dermatologists (33.7). Several patient factors appear correlated with these differences, including the number of prescription drugs and psoriasis severity scores.

Patients rated satisfaction with their treatment on a 5-point scale (1=Very Unsatisfied, 5=Very Satisfied).  Etanercept had the highest satisfaction rating and cyclosporine A was lowest. Ratings for the 5 most frequently used treatments reported were:

Etanercept (n=138): 3.93±1.33; very satisfied (VS): 50%

Adalimumab (n=144): 3.48±1.52; VS: 37%

Methotrexate (n=204): 3.45±1.43; VS: 30%

Infliximab (n=51): 3.12±1.58; VS: 26%

Sulfasalazine (n=46): 2.50±1.63; VS: 17%

cyclosporine A (n=19): 2.32±1.46; VS: 6%

Conclusion:

Survey results suggest that PsA may be a very aggressive disease and that despite new targeted treatments, many patients are still not doing too well. Limitations do exist with survey methodology however, results may be used to improve patient outcomes and generate critical measures for further study such as provider satisfaction.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-the-real-life-impact-of-psoriatic-arthritis-on-disability-quality-of-life-and-provider-satisfaction/