Background/Purpose: Psoriatic arthritis (PsA) is consider a multifaceted disease, with patients reporting lower health-related quality of life (HRQoL). Data of burden of disease is substantial and there exists a need for properly designed studies to learn more about the evolution of HRQoL in this condition. Purpose: To analyze the evolution on HRQoL in patients with PsA and to evaluate factors that may influence this evolution.

Methods: Retrospective longitudinal observational study including incident patients diagnosed with PsA from 2007 to 2016, and followed-up until loss of follow-up or December 2017; with at least two registered visits; PsA diagnosis according to The CASPAR criteria (ClASsification criteria for Psoriatic ARthritis) and symptoms onset after 16 years old. Patients were from the rheumatology outpatient clinic of Hospital Clínico San Carlos, Madrid, Spain. Clinical information was collected from a departmental electronic health record, including demographic, clinical, treatment, and HRQoL related variables (measured with the Rosser Classification Index), reported numerically on a scale between 0 and 1, as a result of the combination of two different categories disability and distress; The influence of these variables in repeated measures of HRQoL were analysed using bivariate and multivariate generalized estimating equations (GEE) models nested by patient. Those variables with a p-value < 0.20 (plus age, sex, follow-up time, and calendar year) were introduced in the multivariate analysis. Bonferroni p-value threshold adjustment was carried out.

Results: We included 248 patients, with a median follow-up of 4.3±3.3 years. 57.6% were male, with a median age at the onset of symptoms and diagnosis of 48 and 49 years, respectively. 88% of patients had a personal history of Psoriasis. Regarding clinical manifestations during the follow-up, 86%, 33%, 35%, and 30% of the patients presented with peripheral arthritis, inflammatory low back pain, enthesitis and dactylitis, respectively. In addition, they received treatment with nonsteroidal antiinflammatory medications (NSAIDs), oral glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) 74%, 59% and 86%, respectively. 22% received biological agents. The Rosser mean value (SD) at the first visit was 0.98 (0.02), with a slight improvement after the first 2 years and worsening after 5 years of follow-up (Graph 1). Regarding to the variables independently associated with HRQoL during follow-up, obesity (p=0.018), osteoporosis (p=1.3e-03), osteoporotic fractures (p=5.7e-12) and chronic obstructive pulmonary disease (p=6.7e-06) were associated with a poorer HRQoL. Conversely, treatment with methotrexate (p=8.2e-05), and the use of bisphosphonates (p=4.9e-04) were associated with better HRQoL. Interestingly the presence of enthesitis was also associated to worse HRQoL, although not significantly after p-value adjustment.

Conclusion: We observed that the presence of certain comorbidities were independently associated with a worse HRQoL. In addition, regarding different treatments, the use of methotrexate and the concomitant use of treatment with bisphosphonates were independently associated with a better HRQoL.

Graph1

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evolution-of-health-related-quality-of-life-in-psoriatic-arthritis-patients/