Psoriatic Arthritis Impact Of Disease Questionnaire Research Articles

How do patient reported outcome measures affect treatment intensification and patient satisfaction in the management of psoriatic arthritis? A cross sectional study of 503 patients.

The ASSIST study investigated prescribing in routine psoriatic arthritis (PsA) care and whether the patient reported outcome: PsA Impact of Disease questionnaire (PsAID-12), impacted treatment. This study also assessed a range of patient and clinician factors and their relationship to PsAID-12 scoring and treatment modification. Patients with PsA were selected across the UK and Europe between July 2021-March 2022. Patients completed the PsAID questionnaire, with the results shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded. 503 patients recruited. 36.2% had changes made to treatment, 88.8% of this had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; the PsAID-12 score was associated with odds of treatment escalation (OR: 1.58; p< 0.0001). However, most clinicians reported PsAID-12 did not impact their decision to escalate treatment, instead supporting treatment reduction decisions. Physician's assessment of disease activity had the most statistically significant effect on likelihood of treatment escalation, (OR = 2.68, per 1-point score increase). Escalation was more likely in patients not treated with biologic therapies. Additional factors associated with treatment escalation included: patient characteristics, physician characteristics, disease activity and disease impact. This study highlights multiple factors impacting treatment decision making for individuals with PsA. PsAID-12 scoring correlates with multiple measures of disease severity and odds of treatment escalation. However, most clinicians reported the PsAID-12 did not influence treatment escalation decisions. PsAID scoring could be used to increase confidence in treatment de-escalation.

FRI0349 PSORIATIC ARTHRITIS AND CENTRAL OBESITY: STRONG ASSOCIATION WITH FUNCTIONAL DISABILITY AND A WORSE QUALITY OF LIFE

Background:Psoriatic arthritis (PsA) is a chronic inflammatory arthritis associated with comorbidities like obesity, metabolic syndrome, and cardiovascular disease. Adipose tissue leads to a pro-inflammatory status in obese subjects. For this reason, central obesity may determine a worsening in both disability index or quality of life in PsA patients treated with biologic agents.Objectives:Our study aimed to evaluate the relationship between central obesity and disability index or the impact of the disease on quality of life in a real-world sample of PsA patients.Methods:A cross-sectional study was conducted. Patients with PsA were enrolled at the PsA clinic at the ARNAS Civico in Palermo (Italy) from March 2018 to December 2019. Clinical, pharmacological, anthropometric, laboratoristic variables, and patient-reported outcomes, including the Health Assessment Questionnaire (HAQ) and Psoriatic Arthritis Impact of Disease (PsAID) were evaluated. STATA 14.1 was used to perform statistical analysis.Results:A total of 143 outpatients aged 55.6 (47.7-63.7) affected by PsA, according to CASPAR criteria, were consecutively evaluated. The average years of illness were 10.8 (9.5-12.1). Patients were treated with biological therapy (81.3%), DMARDS (41.6%), small molecules (9.9%), or their combinations. Both sexes were equally represented. 71.9% of enrolled patients had central obesity (64.9% men and 78.1% women) with an average waist circumference of 104.2 (101.8 - 106.6) for women and 103.6 (100.0 -107.2) for men. Average HAQ was 1.05 (0.92 - 1.19), and data analysis showed 50.3% of patients with normal-mild functional disability, 30.1% moderate to severe disability, and 19.6% severe to very severe disability [Fig 1]. 51,7% of the sample had a high impact of the disease on life, according to the PsAID questionnaire [Fig 2]. A strong association was observed between functional disability measured by HAQ &gt;2 and central obesity [OR (95% CI) 16.94 (2.22 - 129.48); p &lt; 0.006]. Moreover, data analysis showed an association between high impact of disease on life (PsAID &gt;4) and central obesity [OR (95% CI) 3.33 (1.56 - 7.13); p&lt;0,002].Fig 1.Functional disability on PsA patientsFig 2.Impact of disease on PsA patients quality of lifeTable.Week 24 Treatment-Interaction Outcomes Adjusted by Sex and BMIConclusion:Our study demonstrated a high association between functional disability studied subjectively using the HAQ, the impact of the disease on patients’ quality of life using PsAID, and central obesity in Sicilian outpatients affected by PsA. Data suggest that therapeutic goals should not be focused on treatment but also on waist circumference reduction in order to reduce inflammation and improve patients’ functional ability and quality of life.

Disease features associated with a low disease impact in patients with psoriatic arthritis: results of a cross-sectional multicenter study

BackgroundPatient-reported outcomes measures, such as those provided by the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, have been found to be a reliable indicator of change during treatment, predictive of long-term outcomes, and the impact of psoriatic arthritis (PsA) on patients’ lives. The objective of the study was to describe the demographic and clinical characteristics of PsA patients with a low disease impact and to analyze predictive factors for that state.MethodsPost hoc analysis of a cross-sectional multicenter study that included 223 consecutive patients. PsAID questionnaire was used to estimate disease impact. Patients with a PsAID < 4 were considered in low disease impact. Minimal disease activity (MDA) response and the Health Assessment Questionnaire (HAQ) were also assessed. The degree of agreement between the different outcomes was addressed by Cohen’s kappa index.ResultsOne hundred and twenty-two (54.7%) patients reached a PsAID < 4. Among them, 52.0% and 68.0% presented articular or skin remission, respectively. Almost 75% of patients were in MDA state and 85.2% presented a low disability state according to the HAQ. A moderate concordance between HAQ ≤ 0.5 and PsAID < 4 (k = 0.53), fair between MDA and PsAID < 4 (k = 0.36), and moderate between DAPSA remission and PsAID < 4 (k = 0.46) was observed. Multivariate logistic regression analysis showed that patients with distal interphalangeal joint (DIP) disease (OR 0.40, 95%CI, 0.20–0.79, p = 0.009), family history of PsA (OR 0.25, 95%CI, 0.09–0.72, p = 0.010), and higher C-reactive protein (OR 0.92, 95%CI, 0.85–0.99, p = 0.036) were significantly less likely to reach a PsAID < 4.ConclusionsThere is certain discrepancy between disease activity measures and a low impact of disease in PsA. Clinical features (DIP joint involvement), biologic activity, and genetic factors (familial history) seem to be associated with lower odds of reaching a low disease impact.

EP41 The Multidimensional Health Assessment Questionnaire (MDHAQ) and the Heath Assessment Questionnaire Disability Index (HAQDI): a comparison in patients with psoriatic arthritis

Abstract Background We compared the Health Assessment Questionnaire Disability Index (HAQDI) and the simpler Multidimensional Health Assessment Questionnaire (MDHAQ) in patients with psoriatic arthritis (PsA), and examined whether either questionnaires are less prone to ‘floor effects’, whereby patients report normal scores despite experiencing functional impairment. Methods Data were collected prospectively across three UK hospital trusts from 2018-2019. All patients completed the MDHAQ, HAQDI and PsA Impact of Disease Questionnaire (PsAID) in a single clinic visit. A subset were given an identical pack to complete one week later. The HAQ questionnaires are scored from 0-3, and the PsAID is scored from 0-10. The PsAID has a validated patient acceptable symptom state (PsAID≤4) to stratify high-impact and low-impact disease. Mean with standard deviation (S.D.) was calculated and variability was assessed using the Bland-Altman method. Intraclass correlation coefficients (ICC, two-way mixed model absolute agreement) was used to assess test-retest reliability. Using pilot data, we calculated that 210 patients were required to detect non-inferiority between the HAQ questionnaires, with a 0.125 margin at a two-sided 0.025 significance level with &amp;gt; 90% power. All analyses were performed using R. This study was approved by London-Surrey Research Ethics Committee. Results 210 patients completed the study; one withdrew consent thus 209 were analysed. 62 patients completed the questionnaires one week later. 60.0% were male, mean age was 51.7 years, and median PsA duration was 7.0 years. In clinic, mean (S.D.) scores on the MDHAQ, HAQDI including/excluding aids, and PsAID were 0.58 (0.64), 0.79 (0.78), 0.70 (0.73), and 3.71 (2.70), respectively. The mean HAQDI tends to be higher than the MDHAQ, for both high and low-impact disease. However, the difference between the two mostly lies within 1.96 S.D. of the mean using the Bland-Altman method, suggesting reasonable agreement. Comparing clinic and 1-week scores, the ICCs for the MDHAQ, HAQDI including/excluding aids, and PsAID were 0.97 (95% CI 0.95-0.98), 0.98 (0.97-0.99), 0.98 (0.96-0.99), and 0.96 (0.93-0.97) respectively, suggesting excellent test-retest reliability. Patients scoring ‘0’ in MDHAQ and HAQDI including/excluding aids were similar (48, 47, 49). Using a score of ≤ 0.5 for low functional impairment, 23 patients had a MDHAQ ≤ 0.5 when their HAQDI including aids &amp;gt; 0.5. This reduced to 17 when using HAQDI excluding aids &amp;gt; 0.5. In contrast, 4 patients had a HAQDI including aids ≤ 0.5 when MDHAQ &amp;gt; 0.5. This increased to 5 patients when using HAQDI excluding aids ≤ 5. Collectively, this suggests the HAQDI is less prone to floor effects compared to the MDHAQ, especially when the score incorporates aids. Conclusion The MDHAQ and HAQDI scores show test-retest reliability and reasonable agreement in patients with PsA. Although the MDHAQ is quicker for patients to complete, it appears more prone to floor effects. Disclosures: W. Ye: None. S. Hackett: None. C. Vandevelde: None. S. Twigg: None. L.C. Coates: None.

A systematic review of measurement properties of patient reported outcome measures in psoriatic arthritis: A GRAPPA-OMERACT initiative.

An updated psoriatic arthritis (PsA) core outcome set (COS) for randomized controlled trials (RCTs) was endorsed at the Outcome Measures in Rheumatology (OMERACT) meeting in 2016. To synthesize the evidence on measurement properties of patient reported outcome measures (PROMs) for PsA and thereby contribute to development of a PsA core outcome measurement set (COMS) as described by the OMERACT Filter 2.0. A systematic literature search was performed in EMBASE, MEDLINE and PsycINFO on Jan 1, 2017 to identify full-text articles with an aim of assessing the measurement properties of PROMs in PsA. Two independent reviewers rated the quality of studies using the COnsensus based standards for the Selection of health Measurement INstruments (COSMIN) checklist, and performed a qualitative evidence synthesis. Fifty-five studies were included in the systematic review. Forty-four instruments and a total of 89 scales were analyzed. PROMs measuring COS domains with at least fair quality evidence for good validity and reliability (and no evidence for poor properties) included the Stockerau Activity Score for PsA (German), Psoriasis Symptom Inventory, visual analogue scale for Patient Global, 36 Item Short Form Health Survey Physical Function subscale, Health Assessment Questionnaire Disability Index, Bath Ankylosing Spondylitis Functional Index, PsA Impact of Disease questionnaire, PsA Quality of Life questionnaire, VITACORA-19, Functional Assessment of Chronic Illness Therapy Fatigue scale and Social Role Participation Questionnaire. At least one PROM with some evidence for aspects of validity and reliability was available for six of the eight mandatory domains of the PsA COS.

Minimal disease activity and impact of disease in psoriatic arthritis: a Spanish cross-sectional multicenter study

BackgroundPatients with psoriatic arthritis (PsA) experience functional impairment and reduced quality of life, and thus patient global assessment in PsA is explained mainly by the physical, but also by the psychological, aspect of the disease. To assess the prevalence of minimal disease activity (MDA) in Spanish patients with PsA, we examined their characteristics and the association between MDA and the impact of the disease as assessed by the PsA Impact of Disease (PsAID) questionnaire.MethodsA cross-sectional multicenter study was carried out in patients who fulfilled the Classification for Psoriatic Arthritis (CASPAR) criteria with at least 1 year of disease duration, and who were treated with biological or conventional synthetic (cs) disease-modifying anti-rheumatic drugs (DMARDs) according to routine clinical practice in Spain. Patients were considered in MDA if they met at least 5/7 of the MDA criteria. The association between MDA and the recently developed PsAID questionnaire was also recorded.ResultsOf 227 patients included, 133 (58.6%) were in the MDA state (52% with antitumor necrosis factor (anti-TNF)α monotherapy, 24% with csDMARD monotherapy, and 24% with anti-TNFα in combination with csDMARD). Using multivariate logistic regression analysis, male gender (odds ratio (OR) 2.74, p = 0.001), a sedentary lifestyle (OR 3.13, p = 0.002), familial history of PsA (OR 0.38, p = 0.036), C-reactive protein (CRP) level (OR 0.92, p = 0.010), and use of corticoids (OR 0.33, p = 0.007) were considered features related to MDA. MDA patients had a significantly lower impact of the disease according to PsAID (mean total score (SD): MDA 3.3 (3.1) vs. non-MDA 7.1 (5.2); p < 0.001).ConclusionsNearly 60% of Spanish PsA patients achieve MDA in routine clinical practice. MDA remains one of the most useful therapeutic targets for PsA since patients who reached this state also had a significantly lower impact of disease according to PsAID.