Background Psoriatic arthritis (PSA) is a chronic condition that affects up to 1% of the general population and is associated with progressive joint damage, disability, and serious co-morbidities.
To assess and compare utilization of healthcare services by patients with Early (EPsA) and Established (EstPsA) PsA
To assess patients’ Quality of Life over 12 months
Methods 151 patients with PsA were recruited from a rheumatology clinic and followed prospectively for a 12-month period. Fifty eight patients had EPsA and 93 had EstPsA (defined as <2 and ≥2 years from onset of arthritis symptoms, respectively). The HCU was examined using “Health Care Utilization Resource Use” form. The QoL was evaluated using EUROQOL-5D and SF36 tools. The association of disease severity with patients’ utilization of health care services and their QoL were also analyzed and compared between two cohorts.
Results At baseline, patients with EPsA utilized more health care services for arthritis and co-morbidities (e.g. CHD, Diabetes and Infections) than those with EstPsA: “ER” (0.12 vs. 0.09), “Doctor’s Office Visit” (0.91 vs. 0.72), “Specialist Visit” (0.86 vs.0.73), “Psychologist/Counsellor”(0.07vs.0.05) and “Physiotherapy/Rehabilitation” (0.26 vs. 0.19). Patients with EstPsA used more “Walk in Clinic” (0.12 vs. 0.09) and “Hospital Admittance” (0.05 vs. 0.02) services.
DAS28 was strongly associated with HCU in both cohorts (EPsA: OR=1.3, p=0.049, 95%CI 1.0-1.7; EstPsA: OR=1.6, p=0.001, 95%CI 1.2-2.1). DAS28 and HAQ significantly correlated with QoL in both cohorts: EPsA: r=-0.28, p=0.002 and r=-0.41, p<0.001, respectively; EstPsA: r=-0.35, p<0.001 and r=-0.43, p<0.001, respectively. By 12 months, EPsA patients non-significantly improved their Physical Health, while EstPsA patients showed significant improvement in both Physical (48.3 vs. 56.4, p=0.021) and Mental (61.1 vs. 68.2, p=0.026) components of SF36. EQ-5D Visual Analog Scale also showed significant improvement for EstPsA patients.
Conclusions PsA causes considerable disability and affects the QoL of patients even at early stages of the disease. Traditionally, it was felt that longer disease duration leads to greater health care utilization. However, our findings showed that patients with EPsA seem to utilize more health care services. Early initiation of treatment with DMARDs may reduce the burden of PsA on the health care system and improve patients’ well-being and quality of life.
Disclosure of Interest M. Khraishi Grant/research support from: Dr. Khraishi received non restricted research grants from Hoffman-La Roche Canada, Amgen and Pfizer Canada, and Abbott Canada, R. Aslanov: None Declared, S. Khraishi: None Declared, H. Zurel: None Declared