Need for Improvement in Current Treatment of Psoriatic Arthritis: Study of an Outpatient Clinic Population

2017 ◽  
Vol 44 (4) ◽  
pp. 431-436 ◽  
Author(s):  
Brigitte Michelsen ◽  
Andreas P. Diamantopoulos ◽  
Hege Kilander Høiberg ◽  
Dag Magnar Soldal ◽  
Arthur Kavanaugh ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Activity Index ◽  
Real Life ◽  
Disease Activity Index ◽  
Activity Score ◽  
Psoriatic Skin ◽  
Biologic Treatment ◽  
Remission Criteria

Objective.To explore the burden of skin, joint, and entheses manifestations in a representative psoriatic arthritis (PsA) outpatient cohort in the biologic treatment era.Methods.This was a cross-sectional study of 141 PsA outpatients fulfilling the ClASsification for Psoriatic ARthritis (CASPAR) criteria and examined between January 2013 and May 2014. Selected disease activity measures were explored including Disease Activity index for PSoriatic Arthritis (DAPSA), Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic Arthritis Disease Activity Score (PASDAS), Disease Activity Score for 28 joints (DAS28), Simplified Disease Activity Index (SDAI), and Psoriasis Area Severity Index (PASI). Dermatology Life Quality Index (DLQI), minimal disease activity (MDA), and remission criteria were assessed.Results.Median (range) DAPSA was 14.5 (0.1–76.4), CPDAI 5 (1–11), PASDAS 3.1 (2.1–4.2), DAS28-erythrocyte sedimentation rate (ESR) 3.2 (0.6–6.4), SDAI 8.6 (0.1–39.5), PASI 1.2 (0.0–19.7), and DLQI 2.0 (0–17). The MDA criteria were fulfilled by 22.9% of the patients. DAPSA ≤ 4, CPDAI ≤ 2, PASDAS < 2.4, DAS28-ESR < 2.4, SDAI < 3.3, and Boolean’s remission criteria were fulfilled by 12.1, 9.3, 7.8, 26.2, 21.3, and 5.7% of patients, respectively. The number of satisfied patients was similar regardless of whether the group was treated with tumor necrosis factor inhibitors.Conclusion.Our real-life data indicate that there is still a need for improvement in today’s treatment of PsA. Musculoskeletal inflammatory involvement was more prominent than psoriatic skin involvement. Only a few patients fulfilled the DAPSA, PASDAS, and CPDAI remission criteria, and about a quarter fulfilled the MDA criteria. Considerably fewer patients fulfilled PsA-specific remission criteria versus non-PsA specific remission criteria. Still, patient satisfaction was good and PASI and DLQI were low.

scholarly journals Performance of composite measures used in a trial of etanercept and methotrexate as monotherapy or in combination in psoriatic arthritis

Rheumatology ◽  
2020 ◽  
Author(s):  
Laura C Coates ◽  
Joseph F Merola ◽  
Philip J Mease ◽  
Alexis Ogdie ◽  
Dafna D Gladman ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Activity Index ◽  
Controlled Trial ◽  
Disease Activity Index ◽  
Activity Score ◽  
Composite Measures ◽  
End Point ◽  
Multiple Domains

Abstract Objectives To examine which composite measures are most sensitive to change when measuring psoriatic arthritis (PsA) disease activity, analyses compared the responsiveness of composite measures used in a 48-week randomized, controlled trial of MTX and etanercept in patients with PsA. Methods The trial randomised 851 patients to receive weekly: MTX (20 mg/week), etanercept (50 mg/week) or MTX plus etanercept. Dichotomous composite measures examined included ACR 20/50/70 responses, minimal disease activity (MDA) and very low disease activity (VLDA). Continuous composite measures examined included Disease Activity Score (28 joints) using CRP (DAS28-CRP), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Disease Activity for Psoriatic Arthritis (DAPSA) and Psoriatic Arthritis Disease Activity Score (PASDAS). Results At week 24, etanercept-treated groups were significantly more effective than MTX monotherapy to achieve ACR 20 (primary end point) and MDA (key secondary end point). When examining score changes from baseline at week 24 across the five continuous composite measures, PASDAS demonstrated relatively greater changes in the etanercept-treated groups compared with MTX monotherapy and had the largest effect size and standardized response. Joint count changes drove overall score changes at week 24 from baseline in all the continuous composite measures except for PASDAS, which was driven by the Physician and Patient Global Assessments. Conclusion PASDAS was the most sensitive continuous composite measure examined with results that mirrored the protocol-defined primary and key secondary outcomes. Composite measures with multiple domains, such as PASDAS, may better quantify change in PsA disease burden. Trail registration https://ClinicalTrials.gov, number NCT02376790.

scholarly journals Disease Activity in Psoriatic Arthritis: Comparison of the Discriminative Capacity and Construct Validity of Six Composite Indices in a Real World

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Fausto Salaffi ◽  
Alessandro Ciapetti ◽  
Marina Carotti ◽  
Stefania Gasparini ◽  
Marwin Gutierrez
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Real World ◽  
Disease Activity Score ◽  
Activity Index ◽  
Mental Component Summary Score ◽  
Disease Activity Index ◽  
Activity Score ◽  
Patient Reported ◽  
Activity Indices

Objective. To compare, “in a real world,” the performance of the most common composite activity indices in a cohort of PsA patients.Methods. A total of 171 PsA patients were involved. The following variables were evaluated: peripheral joint assessment, patient reported of pain, physician and patient assessments of disease activity, patient general health status, dactylitis digit count, Leeds Enthesitis Index, Health Assessment Questionnaire (HAQ), physical and mental component summary score of the Medical Outcome Survey (SF-36), Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). To measure the disease activity, the Disease Activity Score (DAS28-ESR and DAS28-CRP), Simple Disease Activity Index (SDAI), Composite Psoriatic Disease Activity Index (CPDAI), disease activity in psoriatic arthritis (DAPSA), and Psoriatic Arthritis Disease Activity Score (PASDAS) have been calculated. The criteria for minimal disease activity (MDA) and remission were applied as external criterion.Results. The ROC were similar in all the composite measures. Only the CPDAI showed less discriminative ability. There was a high degree of correlation between all the indices (P<0.0001). The highest correlations were between DAPSA and SDAI (rho = 0.996) and between DAPSA and DAS28-CRP (rho = 0.957). CPDAI, DAPSA, and PASDAS had the most stringent definitions of remission and MDA category. DAS28-ESR and DAS28-CRP had the highest proportions in remission and MDA.Conclusions. Although a good concurrent validity and discriminant capacity of six disease activity indices were observed, the proportions of patients classified in the disease activity levels differed. In particular, the rate of patients in remission was clearly different among the respective indices.

scholarly journals ПЕРЕБІГ COVID-19 ІНФЕКЦІЇ У ПАЦІЄНТІВ З ЗАПАЛЬНИМИ ЗАХВОРЮВАННЯМИ СУГЛОБІВ

2021 ◽  
pp. 392-396
Author(s):  
Олена Грішина ◽  
Олена Менкус
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Activity Index ◽  
Disease Activity Index ◽  
Activity Score ◽  
Das 28

Метою цієї роботи є оцінка клінічної симптоматики COVID-19 інфекції у пацієнтів з запальними захворюваннями суглобів (ЗЗС) на тлі різних видів базисної терапії. Дана робота є фрагментом моноцентрового ретроспективного дослідження. Для оцінки впливу ЗЗС на симптоматику COVID-19 інфекції використані елементи дизайну «випадок-контроль». Показано, що у пацієнтів з ЗЗС (n = 32) з низькою активністю процесу або в стадії ремісії на тлі прийому будь-яких хворобомодифікуючих антиревматичних препаратів (ХМАРП) (синтетичних, біологічних, таргетних) перебіг захворювання було порівняно з таким у групі контролю (n = 96). Рідше зазначалося підвищення температури вище 380С, відношення шансів (ВШ) 2,84, 95% довірливий інтервал (ДВ) 1,24 - 6,51. Легкий перебіг інфекції зазначався у 18 (56,3%) пацієнтів з ЗЗС, помірний - у 14 (43,7%), важкого перебігу у наших пацієнтів не було відзначено. Гострий COVID-19 зустрівся у 23 (71.9%) пацієнтів, постійна симптоматика COVID-19 - у 9 (29,1%) пацієнтів з ЗЗС, post-COVID-19 і long-COVID-19 не зустрілися. Було оцінено перебіг основного захворювання до (в межах 3 місяців) COVID-19 інфекції і після (через 3 місяці) початку COVID-19 інфекції. Активність ревматоїдного артриту (РА) при первинному обстеженні з використанням Disease Activity Score (DAS) 28 (С-РБ) та повторному склала 2.3±0,7 vs 2.5±0,7, р=0.57. ASDAS (С-РБ) був використаний для оцінки активности АС та склав: 1.5±0,4 до і 1.7±0,4 після, р=0.31. Сумарна оцінка BASDAI (Bath AS Disease Activity Index) у пацієнтів з АС та Нр-АСпА: 2.8±0,7 vs 3.1±0,9 р=0.34. Для пацієнтів з ПсА розраховували PASDAS (Psoriatic Arthritis Disease Activity Score): 1.8±0,5 vs 2.1±0,6 р=0.27. Іншими словами, COVID-19 інфекція не привела до загострення ВЗС. Ці дані свідчать про важливість диференційованого підходу до модифікації лікування ЗЗС на період хвороби COVID-19 інфекції. На 4-й - 6-му тижні від дебюту COVID-19 у всіх пацієнтів з ЗЗС і 31 в контрольній групі визначалися антитіла IgG до SARS-CoV-2. В результаті в групі пацієнтів ЗЗС (n = 32) індекс позитивності склав (М ± SD) 3,9 ± 1,2 (ранги 1,4 - 6,9), а в контрольній групі (n = 31) 5,1 ± 1,7 (ранги 2,3 - 7,8), р = 0.001. У жодного з пацієнтів не було відзначено відсутність вироблення антитіл, хоча, безумовно, їх титр був нижче, ніж в групі контролю. В результаті можна сказати, що низька активність ЗЗС або ремісія можуть служити хорошим прогнозом перебігу та наслідків COVID-19. Для досягнення цієї мети можуть використовуватися, як синтетичні ХМАРП препарати, так і біологічні, і таргетні.

scholarly journals Comparison of disease activity measures in early psoriatic arthritis in usual care

Rheumatology ◽  
2019 ◽  
Vol 58 (12) ◽  
pp. 2251-2259 ◽  
Author(s):  
Kim Wervers ◽  
Jolanda J Luime ◽  
Ilja Tchetverikov ◽  
Andreas H Gerards ◽  
Marc R Kok ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Disease Activity ◽  
Usual Care ◽  
General Health ◽  
Disease Activity Score ◽  
Activity Index ◽  
Disease Activity Index ◽  
Activity Score ◽  
Continuous Measure ◽  
Longitudinal Validity

Abstract Objectives To compare responsiveness and longitudinal validity of Disease Activity Score 28 (DAS28), Disease Activity index for PSoriatic Arthritis (DAPSA), Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic ArthritiS Disease Activity Score (PASDAS), GRAppa Composite scorE (GRACE) and Minimal Disease Activity (MDA) in usual care PsA patients, within 1 year after diagnosis. Methods Data collected in the Dutch southwest early PsA cohort (DEPAR) were used. Responsiveness was assessed using effect size (ES), standardized response mean (SRM), and discrimination between different general health states. Longitudinal validity was tested using mixed models with outcomes health-related quality of life (HRQOL), productivity and disability. Results Responsiveness was highest for PASDAS, with ES 1.00 and SRM 0.95, lowest for DAPSA, with ES 0.73 and SRM 0.71, and in between for DAS28, CPDAI and GRACE. Differences in general health were best discriminated with PASDAS and GRACE. Patients reporting stable or worsening general health could not be distinguished by DAS28 or CPDAI. Discrimination was better using DAPSA, but worse than when using PASDAS and GRACE. Longitudinal evolvement of HRQOL and productivity had the highest association with low disease activity according to GRACE, followed by PASDAS, MDA, DAPSA, DAS28, with the lowest association for CPDAI. Conclusion PASDAS and GRACE were superior with respect to responsiveness, and together with MDA best related to longitudinal evolvement of HRQOL, productivity and disability. Responsiveness and longitudinal validity of most outcomes were inferior for DAS28, DAPSA and CPDAI. As alternatives to the continuous measure DAPSA, use of PASDAS or GRACE should be considered.

scholarly journals Baricitinib in the treatment of rheumatoid arthritis: clinical and ultrasound evaluation of a real-life single-centre experience

2021 ◽  
Vol 13 ◽  
pp. 1759720X2110140
Author(s):  
Giulia Tesei ◽  
Laura Cometi ◽  
Francesca Nacci ◽  
Riccardo Terenzi ◽  
Lorenzo Tofani ◽  
...  
Keyword(s):  
Disease Activity ◽  
Disease Activity Score ◽  
Activity Index ◽  
Power Doppler ◽  
Health Assessment ◽  
Real Life ◽  
Disease Activity Index ◽  
Activity Score ◽  
Ultrasound Evaluation ◽  
Steroid Dosage

Background: Ultrasound (US) is useful in monitoring RA patients, with the US7 score allowing grey-scale and power-Doppler (PD) semi-quantitative evaluation of synovitis and teno-synovitis. We evaluated real-life efficacy and safety of Baricitinib, an oral selective JAK1-2 inhibitor, in RA patients using clinical, clinimetric, and US assessments. Methods: Disease activity score in 28 joints calculated with C-reactive protein (DAS28-CRP), disease activity score in 28 joints calculated with erythrocyte sedimentation rate (DAS28-ESR), clinical disease activity index (CDAI), simplified disease activity index (SDAI), visual analogue scale (VAS)-pain, health assessment questionnaire (HAQ), COCHIN scale, adverse events (AE), concomitant medications, laboratory parameters, and US7 were performed/recorded at baseline, 1, 3, and 6 months in RA patients starting Baricitinib. Responder/non-responder status was determined according to the EULAR Response Criteria at 3 months. SDAI clinical remission or low disease activity (LDA) were calculated at 3 and 6 months. Results: In 43 enrolled patients, a significant improvement in disease activity and US7 components (except tendon PD) and a reduction of steroid dosage were observed. Responders at 3 months showed a significantly higher reduction of CDAI, SDAI, COCHIN scale, VAS-pain, and US7 synovialPD, compared with non-responders. At 3 and 6 months, remission/LDA was achieved by 12.8/53.8% and 21.6/51.3% patients, respectively. The csDMARD co-treatment was independently associated with remission/LDA at 3 months. Safety-related drop-outs were in line with literature data. The steroid dosage was associated with AE development at 6 months. Conclusion: The real-life data, also obtained with US evaluation, confirmed the Baricitinib efficacy in RA disease control, as well as the utility of assessment during the follow up of disease activity.

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