Session Information
Date: Monday, November 14, 2016
Session Title: Spondylarthropathies and Psoriatic Arthritis – Clinical Aspects and Treatment - Poster II: Psoriatic Arthritis
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: The Composite Psoriatic Disease Activity Index (CPDAI), a composite disease outcome measure in psoriatic arthritis (PsA) (1),has proved to be a valid and discriminative tool to assess disease activity in PsA. Definitions of disease activity statesare lacking, however therecently developed minimal disease activity state (MDA) as a treatment target has been shown to improve outcome in patients with PsA (2). CPDAI has arbitrary cutoff points to classify disease states into mild, moderate and severe disease but these cutoff points have not been validated. Measuring Outcome in Psoriatic Arthritis (MOPsA) is a new web-based tool which can be used in the assessment of PsA.MOPSA calculates both MDA and CPDAI based on patient reported outcomes and assessment by physicians
Methods: We evaluated consecutive PsA patientsincluded in the MOPSA database.Data collected included joint counts, patientpain and global activity ratings, erythrocyte sedimentation rate, the health assessment questionnaire (HAQ) the psoriasis area severity index (PASI), the Bath ankylosing spondylitis disease activity index (BASDAI), the dermatology life quality index (DLQI), the Psoriatic Arthritis Quality of Life (PsAQoL). TheclinicalDisease Activity Index for Psoriatic Arthritis (cDAPSA) was calculated. Recently published cut off values for DAPSA were used to classify patients into remission (REM), low (LDA), moderate (MoDA) or high (HDA) disease activity. Based on the distributions of CPDAI in each of these clinical DAPSA assigned states, we defined the cut points between groups. Disease activity parameters were compared among the different constituted CPDAI states. Changes of treatment at the index visit was also evaluated
Results: Eighty-sevenPsA patients, 41 (52%) males, mean age 49 years (SD: 12 years) were included. Mean CPDAI differed significantly between patients classified as REM, LDA, MoDA or HDA (p<0.001)Cdapsa. Based on the distributions of CPDAI in these groups, we propose cut-off values of <2 for REM, >2 and <4 for LDA, >4 and < 7 for MDA and >7for HDA.With these cut off values 22%, 44%, 14% and 19% of the patients were in REM, LDA, MoDA and HAD, respectively. The table shows results for different disease activity parameters among the four CPDAI states. None of the patients classified as in remission by CPDAI changedDMARDs at the index visit, while 33%, 42% and 53% of patients in LDA, MoDA, and HAD, did undergo a treatment change. Table:Disease Activity Parameters according to CPDAI state
| Disease Activity Parameter | All Patients (n=87) | Remission (n=20) | Low Disease Activity (n=39) | Moderate Disease Activity (n=12) | High Disease Activity (n=16) |
| Fulfilling MDA criteria, n (%) | 33 (38) | 19 (57,6) | 14 (42.4) | 0 (0) | 0 (0) |
| Mean Tender Joint Count (TJC 68) (SD) | 4.2 (6.1) | 0.3 (0.9) | 2.2 (1.7) | 9.75 (10.8) | 10.3 (4.7) |
| Mean Swollen Joint Count (66) (SD) | 1 (2.5) | 0 (0) | 0.72 (1.3) | 0.88 (1.7) | 3.2 (4.8) |
| Mean Patient Pain (VAS 0-10) (SD) | 3.5 (2.7) | 2.45 (2.6) | 3.1 (2.6) | 4.25 (2.3) | 5.4 (2.7) |
| Mean Patient Global Assessment (VAS 0-10) (SD) | 3.5 (2.4) | 2.4 (2.3) | 3.3 (2.1) | 4.3 (2.3) | 4.8 (2.6) |
| Mean HAQ (SD) | 0.6 (0.7) | 0.175 (0.23) | 0.42 (0.5) | 0.85 (0.8) | 1.5 (0.6) |
| Mean BASDAI (SD) | 1.5 (2.3) | 0.22 (0.69) | 0.56 (1) | 2.1 (2.6) | 4.8 (2.2) |
| Mean PASI (SD) | 2.8 (3.4) | 0.7 (1.9) | 2.6 (2.6) | 5.6 (5.5) | 3.7 (2.9) |
| Mean Clinical DAPSA (SD) | 12.4 (10.4) | 5.15 (4.3) | 9.3 (4.2) | 19.2 (14.1) | 23.6 (11.7) |
| Mean DLQI (SD) | 3.5 (5.6) | 1.1 (2.1) | 3.1 (4.3) | 5.1 (7.2) | 6.1 (8.4) |
| Mean PASQOL (SD) | 4.2 (5) | 0.85 (1.9) | 2.9 (3.7) | 6.3 (6) | 9.9 (4.8) |
| Mean erythrocyte sedimentation rate,(SD) | 12.2 (9.6) | 10.3 (7.6) | 11.3 (10.1) | 13.9 (11.6) | 15.1 (8.2) |
Conclusion: CPDAI constitutes a disease-specific,validated and feasible tool for PsA assessment. In thisstudy, we provide criteria for disease activity states that showed good performance in clinical practice
To cite this abstract in AMA style:
Acosta Felquer ML, Szentpetery A, Elmamoun M, Gallagher P, FitzGerald O, Soriano ER. Composite Psoriatic Disease Activity Index (CPDAI), Defining Remission and Disease Activity States Using Data from Daily Clinical Practice [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/composite-psoriatic-disease-activity-index-cpdai-defining-remission-and-disease-activity-states-using-data-from-daily-clinical-practice/. Accessed February 28, 2021.« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/composite-psoriatic-disease-activity-index-cpdai-defining-remission-and-disease-activity-states-using-data-from-daily-clinical-practice/