Background/Purpose: Patient reported outcomes (PRO) provide valuable insights into patientsÕ perceptions of their disease and overall health and function, and these perceptions influence management of their disease.  The objective of this study was to examine patient factors (also termed Òcontextual factorsÓ) that may be associated with the Routine Index of Patient Data (RAPID3) score among patients with psoriatic arthritis (PsA).

Methods: Patients with PsA were enrolled in the Psoriatic Arthritis Research Consortium (PARC) between 2015-2016.  PARC is a longitudinal observational cohort study conducted at four institutions in the United States: University of Pennsylvania, Cleveland Clinic, New York University, and University of Utah. Only baseline data are included in this cross-sectional analysis. Potential contextual factors were defined prior to statistical testing. A contextual factor is defined by OMERACT as a Òvariable that is not an outcome of the study but needs to be recognized and measured in order to understand the study results.Ó  We examined the association between potential contextual factors and RAPID3 scores using univariable linear regression models.  Variables significant at the univariable stage (defined as p<0.05) were included in multivariable linear regression models.  A final model to identify factors with an independent relationship with RAPID3 score after accounting for disease activity (e.g., swollen and tender joint counts, skin global assessment, enthesitis) was formed using backwards selection.

Results: Among the four centers, 401 patients were enrolled; 55% were female, mean age was 51.3, and 76% identified as Caucasian. Using RAPID3 cut-offs designed for RA, the mean disease activity (9.0, SD 6.7) would be categorized as Òmoderate.Ó Contextual factors significantly associated with RAPID3 score were female sex, current alcohol use, body mass index (BMI), depression, education level, and insurance status.  In a multi-variable model insurance status, depression and BMI were most strongly associated with RAPID3 score, after accounting for PsA disease activity.  These factors were similarly associated with the individual components of the RAPID3 (physical function, global assessment, and pain).

Conclusion: In PsA, the RAPID3 score is influenced by depression, insurance status, and obesity.  These factors must be taken into account when using RAPID3 in clinical practice. Additionally, treating depression and improving obesity may be potential targets for improving the overall perception of disease in patients with PsA.