Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries

• Published in: Annals of the rheumatic diseases Vol. 78; no. 2; pp. 201 - 208
• Main Authors: Gorlier, Clémence, Orbai, Ana-Maria, Puyraimond-Zemmour, Déborah, Coates, Laura C, Kiltz, Uta, Leung, Ying-Ying, Palominos, Penelope, Cañete, Juan D, Scrivo, Rossana, Balanescu, Andra, Dernis, Emmanuelle, Tälli, Sandra, Ruyssen-Witrand, Adeline, Soubrier, Martin, Aydin, Sibel Zehra, Eder, Lihi, Gaydukova, Inna, Lubrano, Ennio, Kalyoncu, Umut, Richette, Pascal, Husni, M Elaine, de Wit, Maarten, Smolen, Josef S, Gossec, Laure
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.02.2019; BMJ Publishing Group
• Subjects: Adult; Antirheumatic Agents - therapeutic use; Arthritis; Arthritis, Psoriatic - drug therapy; Arthritis, Psoriatic - psychology; Biological Products - therapeutic use; Clinical medicine; Cross-Sectional Studies; Decision making; Diagnostic Self Evaluation; Female; Health risk assessment; Human health and pathology; Humans; Life Sciences; Male; Middle Aged; Outcome Assessment, Health Care - methods; Outcome Assessment, Health Care - statistics & numerical data; Patients; Physicians - psychology; Psoriasis; Psoriatic arthritis; Questionnaires; Remission; Remission Induction; Reproducibility of Results; Rheumatoid arthritis; Rheumatology; Rhumatology and musculoskeletal system; Severity of Illness Index; Skin; Treatment Outcome; disease activity; patient perspective; psoriatic arthritis
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2018-214140

BackgroundThe objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients’ and physicians’ perspectives.MethodsIn ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA <14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally.ResultsOf 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12–0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions.ConclusionIn this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.