Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Minimal disease activity (MDA) is now considered an attainable target in psoriatic arthritis (PsA) reflecting a desired state of comprehensive disease control. MDA is defined as the fulfillment of ≥5 of the following criteria: TJC28≤1, SJC28≤1, PASI≤1, pain (VAS) ≤15 mm, PtGA (VAS) ≤20 mm, HAQ≤0.5, and tender entheseal points ≤1. It is made up of objective and subjective outcomes. The aim of this analysis is to assess the contribution of each criterion in preventing the achievement of MDA at 6 and 12 months.
Methods: BioTRAC is an ongoing, prospective registry of patients initiating treatment for rheumatoid arthritis (RA), ankylosing spondylitis (AS), or psoriatic arthritis (PsA) with infliximab (IFX) or golimumab (GLM). Eligible patients for this analysis included PsA patients treated with IFX or GLM between 2005 and 2010. Modified MDA (mMDA) was evaluated by removing patient-reported outcomes, one criterion at a time, and mMDA achievement was defined as patients who met 4/6 criteria.
Results: A total of 223 PsA patients (51.4% male) were included with a mean (SD) age of 49.8 (11.1) years and disease duration since diagnosis of 5.4 (6.3) years. MDA was achieved by 11.7%, 43.5%, and 44.8% at baseline, at 6 and 12 months of treatment, respectively. At 6 months of treatment the proportion of patients who achieved mMDA upon removing one criterion at a time increased to 54.3% for pain removal, 52.2% for PtGA removal, 50.7% for HAQ removal; while the removal of objective measures did not increase in substantial manner the percentage of patients achieving mMDA: 46.4% for TJC removal, 44.9% for PASI removal, 44.2% for SJC removal, and 44.2% for enthesitis removal. Similar findings were seen at 12 months: the proportion of patients achieving mMDA upon removing HAQ was 58.1%, pain was 57.1%, PtGA was 55.2%, TJC was 50.5%, SJC was 48.6%, PASI was 46.7%, and enthesitis was 45.7%. The highest proportion of mMDA achievement at 6 and 12 months of treatment was observed upon the removal of patient reported pain, PtGA and HAQ.
Conclusion: The results of the current analysis have shown that the most common limiting factors in achieving MDA in PsA are patient reported outcomes, including PtGA, pain, and HAQ. Elimination of each of these criteria from the MDA formula would result in as many as 13% additional cases of MDA.
To cite this abstract in AMA style:Haraoui B, Rahman P, Bessette L, Baer P, Kapur S, Avina-Zubieta JA, Arendse R, Rampakakis E, Psaradellis E, Maslova K, Lehman AJ, Nantel F, Osborne B, Tkaczyk C. Minimal Disease Activity Among Psoriatic Arthritis Patients in Canada: Evaluation of Modified Minimal Disease Activity upon Elimination of Each Component [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/minimal-disease-activity-among-psoriatic-arthritis-patients-in-canada-evaluation-of-modified-minimal-disease-activity-upon-elimination-of-each-component/. Accessed October 27, 2020.
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