Inconsistencies of the Disease Activity Assessment Tools for Psoriatic Arthritis: Challenges to Rheumatologists

•Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA.•Some patients would not be considered in REM as defined by the DAPSA and/or DAS28-ESR, even though they are free from active joint involvement.•In the context of ar...

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Published in:Joint, bone, spine : revue du rhumatisme bone, spine : revue du rhumatisme, 2022-05, Vol.89 (3), p.105296-105296, Article 105296
Main Authors: Gezer, Halise Hande, Duruöz, Mehmet Tuncay, Nas, Kemal, Kılıç, Erkan, Sargın, Betül, Kasman, Sevtap Acer, Alkan, Hakan, Şahin, Nilay, Cengiz, Gizem, Cüzdan, Nihan, Gezer, İlknur Albayrak, Keskin, Dilek, Mülkoğlu, Cevriye, Reşorlu, Hatice, Sunar, İsmihan, Bal, Ajda, Küçükakkaş, Okan, Yurdakul, Ozan Volkan, Melikoğlu, Meltem Alkan, Baykul, Merve, Ayhan, Fikriye Figen, Bodur, Hatice, Çalış, Mustafa, Çapkın, Erhan, Devrimsel, Gül, Gök, Kevser, Hizmetli, Sami, Kamanlı, Ayhan, Keskin, Yaşar, Ecesoy, Hilal, Kutluk, Öznur, Şen, Nesrin, Şendur, Ömer Faruk, Tekeoğlu, İbrahim, Tolu, Sena, Toprak, Murat, Tuncer, Tiraje
Format: Article
Language:English
Subjects:
Antirheumatic Agents - therapeutic use
Arthritis, Psoriatic - diagnosis
Arthritis, Psoriatic - drug therapy
Composite index
Disease activity
Female
Humans
Male
Middle Aged
Psoriatic arthritis
Remission
Remission Induction
Rheumatologists
Severity of Illness Index
Treatment Outcome
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Summary:•Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA.•Some patients would not be considered in REM as defined by the DAPSA and/or DAS28-ESR, even though they are free from active joint involvement.•In the context of arthritis, the most prominent manifestation is indeed the joint domain; however, some other domains associated with PsA may be underevaluated. Currently, concerning the evaluation of psoriatic arthritis (PsA), there is no agreement on a standardized composite index for disease activity that includes all relevant domains. The present study sought to assess the rates of remission (REM)/low disease activity (LDA) and disease states [minimal disease activity (MDA), very low disease activity (VLDA)] as defined by diverse activity scales (DAPSA, DAS28-ESR) in an attempt to display discrepancies across these assessment tools for peripheral PsA. The study involved 758 patients (496 females, 262 males; mean age 47,1 years) with peripheral PsA who were registered to the Turkish League Against Rheumatism (TLAR) Network. The patients were assessed using the DAS28-ESR, DAPSA, MDA, and VLDA. The overall yield of each scale was assessed in identifying REM and LDA. The presence or absence of swollen joints was separately analysed. The median disease duration was 4 years (range 0-44 years). According to DAPSA and DAS28-ESR, REM was achieved in 6.9% and 19.5% of the patients, respectively. The rates of MDA and VLDA were 16% and 2.9%, respectively. Despite the absence of swollen joints, a significant portion of patients were not considered to be in REM (296 (39.1%) patients with DAS28-ESR, 364 (48%) with DAPSA, and 394 (52%) with VLDA). Patients with peripheral PsA may be assigned to diverse disease activity levels when assessed with the DAS28-ESR, DAPSA, MDA and VLDA, which would inevitably have clinical implications. In patients with PsA a holistic approach seems to be necessary which includes other domains apart from joint involvement, such as skin involvement, enthesitis, spinal involvement, and patient-reported outcomes.
ISSN:1297-319X
1778-7254
DOI:10.1016/j.jbspin.2021.105296