Background/Purpose:  “Composite psoriatic disease activity index (CPDAI)” includes 5 domains: peripheral joints, skin, enthesitis, dactylitis, and spinal manifestations in psoriatic arthritis (PsA) which is a heterogeneous disease known with widely variable clinical courses. Experiences in ankylosing spondylitis (AS) studies suggest that female patients report more symptoms and poorer scores on most of the self-reported questionnaires, including Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI) and AS Quality of Life [ASQoL]) despite fewer inflammatory spinal lesions or less radiographic damage as objective disease indicators with respect to male patients. The aims of this study are to investigate the relationship of CPDAI with other follow-up parameters and to evaluate gender differences in these measures in PsA patients.

Methods:  This cross-sectional study included patients with PsA followed up at a Rheumatology outpatient clinic at a university hospital. Disease activity was assessed in the patients by using the CPDAI, BASDAI, Visual Analogue Scale Global (VAS global) and Disease Activity Score (DAS28). Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were measured in all the patients. The Psoriasis Area and Severity Index (PASI) was used for the measurement of severity of psoriasis. The Patient Acceptable Symptom State (PASS), BASFI, Bath Ankylosing Spondylitis Metrology Index (BASMI), Health Assessment Questionnaire (HAQ), ASQoL and Dermatology Life Quality Index (DLQI) were also evaluated. The correlations were investigated by Spearman’s correlation analysis (rho:<= 0.29 weak, 0.30-0.49 middle, >= 0.50 strong).

Results:  There were 117 patients with PsA (78 female) who fulfilled the Classification Criteria for Psoriatic Arthritis (CASPAR) (3). Their mean CPDAI score was 3.67 (±2.46). The CPDAI was found to be correlated with tender and swollen joint counts, dactylitis and enthesitis. There was a strong correlation between CPDAI and BASDAI, DAS28_ESR, DAS28_CRP and VAS global. Other follow-up parameters also correlated with CPDAI but no correlation was found between the CPDAI and ESR, CRP and BASMI. Mean CPDAI scores were similar in female and male patients. Female patients with PsA were found as having worse subjective scores including BASDAI, VAS global, BASFI, HAQ, ASQoL scores than males (p<0.05). Whereas objective disease parameters such as mean ESR and serum CRP levels, tender/swollen joint counts, DAS28 and BASMI scores were similar in both gender groups (Table 1).

Conclusion:  This study confirmed that the CPDAI, a new scale to assess disease activity in PsA patients was well correlated with other disease activity measurements. Although subjective disease scores (BASDAI, VAS global, BASFI, HAQ and ASQoL) was higher in female patients, CPDAI was not affected from gender.

References: 1. Taylor W. et al. CASPAR Study Group. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum, 2006;54(8):2665-73.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-gender-make-a-difference-in-composite-psoriatic-disease-activity-index-cpdai-in-patients-with-psoriatic-arthritis/