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Patient global assessment may accurately reflect low disease activity in patients with PsA
Patient global assessment accurately measured low disease activity in patients with psoriatic arthritis undergoing treatment with anti-tumor necrosis factor-alpha agents, according to the results of a recently published study.
A group of 124 patients with psoriatic arthritis (PsA) was assessed at baseline before initiation of treatment with anti-tumor necrosis factor-alpha agents (anti-TNF-) and at every 4 months for 1 year between May 1, 2012 and April 30, 2015 at the Academic Rheumatology Unit in Campobasso, Italy. In the waiting room prior to clinical evaluation, a nurse administered the patient global assessment (PtGA) to each patient. During the clinical evaluation, the Disease Activity Score at 28 joints (DAS28) with C-reactive protein (CRP), Disease Activity index for Psoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Psoriasis Area and Severity Index (PASI) and other parameters were used to assess disease activity. Minimal Disease Activity (MDA) was defined as a score of 20 or less on the PtGA based on recommendations by Coates and colleagues.
At baseline, no patients had MDA or a DAPSA score at or below 3.3. The median DAS28-CRP was 3.72, and eight patients had a PtGA score of 20 or below.
The proportion of patients at 4 months with a PtGA of 20 or less was 25.7%. At 8 months, 48.9% of patients had a PtGA score of 20 or less and the proportion increased to 65.3% at 12 months. At 4 months, 8 months and 12 months, the concordance between PtGA and MDA was high and resulted in “good validity of the PtGA as an instrument to assess low disease activity (LDA)/remission,” the researchers wrote. Correlations were observed between PtGA and BASDAI, DAPSA and DAS20-CRP, but not between PtGA and the individual components of the DAPSA or PASI.
“Although PtGA identified many domains of disease activity and status of PsA, it is not considered so comprehensive as to replace all of the process and outcome measures, as well as the objective signs of inflammation (i.e., CRP or [erythrocyte sedimentation rate] ESR,” the researchers wrote. “In fact, it is also a single-item measurement with limited face validity. Our results only suggest that PtGA can be deemed as a surrogate to assess the disease status by the patient’s perspective.” – by Shirley Pulawski
Disclosures: The researchers report no relevant financial disclosures.