How to Define Remission and Low Disease Activity in Psoriatic Arthritis? an Analysis of 419 Patients with a Double Perspective, Based on Composite Scores and Patients' and Physicians' Perspectives

Clémence Gorlier¹, Deborah Puyraimond-Zemmour¹, Laura C. Coates², Ana-Maria Orbai³, Uta Kiltz⁴, Ying Ying Leung⁵, Penelope Palominos⁶, Juan D. Cañete⁷, Rossana Scrivo⁸, Andra Rodica Balanescu⁹, Emmanuelle Dernis¹⁰, Sandra Tälli¹¹, Adeline Ruyssen-Witrand¹², Martin Soubrier¹³, Sibel Zehra Aydın¹⁴, Lihi Eder¹⁵, Inna Gaydukova¹⁶, Ennio Lubrano¹⁷, Pascal Richette¹⁸, M. Elaine Husni¹⁹, Maarten de Wit²⁰, Josef S. Smolen²¹ and Laure Gossec²², ¹Sorbonne Université, PARIS, France, ²University of Oxford, Oxford, United Kingdom, ³Johns Hopkins University School of Medicine, Baltimore, MD, ⁴Rheumazentrum Ruhrgebiet, Herne, Germany, ⁵Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore, ⁶Rheumatology, Hospital de Clinicas de Porto Alegre, Santa Cecilia, Brazil, ⁷Rheumatology, Hospital Clinic and IDIBAPS, Barcelona, Spain, ⁸Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy, ⁹Department of Internal Medicine and Rheumatology “Sf. Maria” Hospital, Bucharest, Romania, ¹⁰Service de Rhumatologie, CH du Mans, Le Mans, France, ¹¹East-Tallinn Central Hospital, Department of Rheumatology, Tallinn, Estonia, ¹²Rheumatology, Purpan Hospital, Toulouse III University, Toulouse, France, ¹³Rheumatology, Department of Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France, ¹⁴University of Ottawa, Ottawa, ON, Canada, ¹⁵Women's College Research Institute, University of Toronto, Women's College Hospital, Toronto, ON, Canada, ¹⁶North-western state medical university n.a. II Mechnikov, St. Petersburg, Russian Federation, ¹⁷Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy, ¹⁸Lariboisière Hospital, Lariboisière, University of Paris 7, Paris, France, ¹⁹Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, ²⁰Dept. Medical Humanities, Amsterdam Public Health (APH), VU University Medical Centre, Amsterdam, Netherlands, ²¹Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria, ²²Sorbonne Universités, Paris, France

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Activity score, Disease Activity, psoriatic arthritis and remission

Session Information

Date: Sunday, October 21, 2018

Session Title: Spondyloarthritis Including Psoriatic Arthritis – Clinical Poster I: Imaging, Clinical Studies, and Treatment

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: Remission (REM) or minimal/low disease activity (LDA) is the treatment goal in Psoriatic Arthritis (PsA). There is no consensus on definitions of REM/LDA. Recently, composite measures of disease activity have been compared but this comparison did not address the patient’s perspective (ref).

The objectives were to assess frequency of REM/LDA using different definitions, and agreement between these definitions according to the patient’s and physician’s perspectives.

Methods: ReFlap (NCT03119805) is a cross-sectional study in 14 countries of consecutive adults with definite PsA and more than 2 years of disease duration. REM and LDA were defined using Very Low Disease Activity (VLDA), Minimal Disease Activity (MDA), Disease Activity in PSoriatic Arthritis (DAPSA), clinical DAPSA (cDAPSA) and Patient Global Assessment (PGA). Furthermore, REM and LDA were assessed using specific single questions for the physician and the patient (Figure 1: physician and patient REM/LDA).

Proportions achieving each REM/LDA criterion were calculated. The agreement between the tested definitions was assessed by Venn diagram and calculation of kappa and prevalence-adjusted and bias-adjusted kappa (PABAK).

Results: Of 466 patients, 419 had data available for all definitions of REM/LDA: 212 (51.3%) were male, mean age was 53.9±12.6 years and mean disease duration 11.3±8.4 years, 59.0% were taking a biologic. Disease activity was moderate: 9.5% had a Body Surface area of psoriasis≥5%, mean Tender and Swollen Joint Counts were respectively 4.9±9.7 and 2.3±7.2. The frequency of REM varied from 12.2% (VLDA) to 21.0% (Physician REM question) and of LDA from 25.1% (MDA) to 46.3% (PGA≤3) (Figure 1). Agreement was moderate between the composite scores for REM (kappa DAPSA/VLDA 0.57, cDAPSA/VLDA 0.59). Agreements were lower for LDA whatever the definition used. Agreement between patient-defined REM/LDA and composite scores was only moderate. In particular, 36/88 (40.9%) of patients in patient-perceived REM were not in REM according to any composite score. Moreover, agreement between patient and physician REM occurred in 58/148 (39.0%) patients (Figure 2).

Conclusion: In this unselected population, REM/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based REM/LDA. Patient-assessed REM/LDA was similar in terms of prevalence to DAPSA, though agreement between patients and composite scores was only moderate. Further studies of patients’ expectations are needed.

Reference. van Mens LJJ et al.Ann Rheum Dis. 2018

Disclosure: C. Gorlier, None; D. Puyraimond-Zemmour, None; L. C. Coates, None; A. M. Orbai, None; U. Kiltz, None; Y. Y. Leung, None; P. Palominos, None; J. D. Cañete, None; R. Scrivo, None; A. R. Balanescu, None; E. Dernis, None; S. Tälli, None; A. Ruyssen-Witrand, None; M. Soubrier, None; S. Z. Aydın, None; L. Eder, None; I. Gaydukova, None; E. Lubrano, None; P. Richette, Fidia, 5, 8; M. E. Husni, None; M. de Wit, None; J. S. Smolen, None; L. Gossec, None.

To cite this abstract in AMA style:

Gorlier C, Puyraimond-Zemmour D, Coates LC, Orbai AM, Kiltz U, Leung YY, Palominos P, Cañete JD, Scrivo R, Balanescu AR, Dernis E, Tälli S, Ruyssen-Witrand A, Soubrier M, Aydın SZ, Eder L, Gaydukova I, Lubrano E, Richette P, Husni ME, de Wit M, Smolen JS, Gossec L. How to Define Remission and Low Disease Activity in Psoriatic Arthritis? an Analysis of 419 Patients with a Double Perspective, Based on Composite Scores and Patients’ and Physicians’ Perspectives [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/how-to-define-remission-and-low-disease-activity-in-psoriatic-arthritis-an-analysis-of-419-patients-with-a-double-perspective-based-on-composite-scores-and-patients-and-physicians-perspecti/. Accessed December 15, 2019.

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