Background/Purpose

Patient global assessment (PGA) is one of the most widely used patient reported outcomes (PROs) in psoriatic arthritis (PsA). PGA should reflect the global impact of the disease from the patient’s perspective, however we lack information on the concepts encompassed in PGA. In addition the Group of Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has proposed to use also two specific (joints, skin) patient assessments but their scope is also unclear. (1) Recently the European League Against Rheumatism (EULAR) developed the PsAID (Psoriatic Arthritis Impact of the Disease) which includes 12 domains of health important for patients. (2)

Objective: to explore PGA in PsA from the patient’s point of view by comparing it to the PsAID domains of health and also to explore the two specific (joints, skin) patient assessments in relation to PGA.

Methods

Post-hoc analysis of the cross-sectional PsAID study (2) for patients with definite PsA (according to the Classification Criteria for Psoriatic Arthritis (CASPAR) criteria). Data collection included PGA (“Considering all the ways PsA has affected you during the last week, circle the number that best describes how you have been doing”), skin and joint patient assessments (patient global assessments of these 2 aspects) and PsAID questions covering physical (including joints and skin), psychological and social impact of PsA. The concepts covered by PGA were explored by univariate (Spearman correlation coefficient) and multivariate linear regression, and intra-class correlation between PGA and joint and skin patient assessments was calculated.

Results

Among 223 patients (mean age 51.0 (standard deviation, ±13.3) years, mean disease duration 9.9 (±10.1) years, mean swollen joint count 4.1 (±5.1), 84.3% with current psoriasis (mainly of less than 5% body surface area)), 51.1% were females. Mean patient assessment values were for PGA 4.8 (±2.7), joint patient assessment 5.6 (±2.5) and skin patient assessment 4.1 (±3.0). Multivariate linear regression indicated that PGA was well explained (R² of model 0.754) by coping (β= 0.287); pain (β= 0.240); work and/or leisure activities (β= 0.141); and anxiety (β= 0.109). Intra-class correlation between PGA and joint or skin patient assessment was respectively 0.71 [95% confidence interval, 0.64-0.77] and 0.52 [95% confidence interval, 0.42-0.60].

Conclusion

PGA in PsA is explained by coping, then as expected physical aspects of impact which may reflect joint involvement: pain and work/leisure activities; and psychological impact: anxiety. In this population, skin related issues were not additional explanatory elements of PGA in multivariate analysis. Finally, joint patient assessment may be redundant with PGA whereas skin patient assessment gives additional information in characterizing the disease and its impact.

References

1. Cauli et al. J Rheum 2011; 38:5.

2. Gossec et al. Ann Rheum Dis 2014;73:1012-1019.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/what-does-the-patient-global-assessment-mean-for-patients-with-psoriatic-arthritis-a-post-hoc-analysis-of-223-patients-with-psoriatic-arthritis/