Background/Purpose: Background/Purpose: Psoriatic arthritis (PsA) is a progressive, chronic, and potentially irreversible inflammatory disorder. Systematic clinical follow-up of PsA patients is necessary to maintain and adjusting the proposed therapy. There are two different disease activity composite index suggested by Treat To Target (1). MDA (2) defines a state of illness and includes joint involvement, skin, enthesis and quality of life questionnaire, while DAPSA (3) stratifies disease activity in remission, low, moderate or high disease activity, and does not evaluate skin, enthesitis neither quality of life. Thus, our work aims to establish if these indexes are comparable and evaluates the feasibility of applying each one of them in the clinical practice of our outpatients.

Methods: Methodology: We used data of 124 outpatients of Clinicals Hospital of Federal University of Pernambuco (HC-UFPE), Brazil, between October 2016 and December 2018, who met the criteria of CASPAR (4) and aged ≥18 years. The study was approved by the local medical research ethics committee (CAAE 08028119.7.0000.8807). MDA was defined as having at least five of the seven items that compose it (painful joints ≤1, swollen joints ≤1, LEI ≤1, PASI ≤1, patient global visual analogue scale (VASptGlobal) ≤20mm, patient pain (VASptPain) ≤15mm and HAQ ≤0.5. DAPSA is calculated with the number of painful + swollen joints + VASptGlobal (0-10 cm) + VASptPain (0-10 cm) + PCR mg/dL and low disease activity or remission (DAPSA-LDA/REM) if ≤14. Average disease burden of patients in MDA and DAPSA-LDA/REM was compared. The agreement between the tested definitions was established using 2×2 tables and calculation of a kappa.

Results: Results: Of the total population (124 patients), MDA was performed in 107 (86.3%), of which 40 (37.4%) reached MDA (minimum 5/7); and DAPSA could be done in 77 (62.1%) patients, of which 48 (62.3%) were in DAPSA LDA/REM. There was a moderate agreement between DAPSA LDA/REM and MDA (kappa=0.544) (95%IC: 0.371 to 0.717) as shown in table 1. All patients in MDA, except 2, were with DAPSA LDA/REM, however, some who achieve DAPSA LDA / REM did not reach the MDA. Of the 14 patients in DAPSA LDA/REM, but not in MDA, did not fill at least 1/7 of the domains, as 6 for the (HAQ), 4 (PASI/BSA), 2 (joint pain and edema), and 2 (enthesitis). In addition, of the 48 patients who reached DAPSA LDA/REM, 6 (12.5%) patients had at least one enthesitis. With regard to the achievement of the disease activity composite indexes, it was not possible to perform the DAPSA in 47 (37.9%) patients, since 34 (27.4%) patients had no CRP result needed to perform calculation and the other 12 had chronic pain secondary to fibromyalgia. In the other hand, was not possible to perform the MDA in 17 (13.7%) because there was no record in the last consultation of the updated BSA/PASI skin or HAQ, or by associating fibromyalgia.

Conclusion: Conclusion: Because they have moderate agreement, both can be used in clinical practice. Though, we believe that MDA could be the more feasible in following-up our patients, noting that the difficulty of performing CRP was the main limitation for DAPSA. Besides, enthesitis was present in 12.5% even when in LDA/REM

table DAPSA REM

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mda-versus-dapsa-applicability-in-a-real-world/