Background Randomized clinical trials (RCT) provide information about efficacy of various agents typically in a controlled, detailed setting. Routine care cohorts, conversely, can add data about patient clinical phenotypes, treatment choices and responses in the 'real world' to better inform the practicing rheumatologists. Studying the true impact of psoriatic arthritis (PsA) and the role of newly available treatment options for patients seen in routine clinical environment may help physicians care for these patients more effectively.
Objectives To study patient characteristics, disease activity, treatment choices and responses in a routine care psoriatic arthritis cohort in a university setting.
Methods New York University Psoriatic Arthritis Cohort (PAC) was established in 2005 as part of the Arthritis Registry Monitoring Database (ARMD) and has been following patients with PsA prospectively, with data collected as part of routine care. At each visit, clinical data is collected through MDHAQ (for function, pain, patient global assessment, fatigue, patient self report joint counts, physician global assessment), and 28 tender and swollen joint counts. In addition, medication history, demographic data and selected laboratory tests are also collected. We analyzed patient characteristics and medication use along with disease activity in our cohort.
Results 497 patients were seen to date (48.5% female, mean age 49.6 yr, disease duration 11.9yr, years of education 16.4, White 64%, Black 1.6%, Hispanic 6.8%, Other 27.6%). No differences were noted between males and females. However, female patients with PsA had significantly worse function (2.0 vs 1.6, p=0.005), pain (4.9 vs 4.2, p=0.006), pt global (4.6 vs 3.7, p=0.001), RAPID 3 scores (11.6 vs 9.4, p=0.001), fatigue (4.6 vs 3.2, p<0.001), and pt reported joint counts by RADAI (9.9 vs 7.9, p=0.017) compared to males with the disease. After adjusting for age and education; pain, patient global scores, RAPID3 scores, and fatigue remained significant. No differences in ESR and duration of morning stiffness were noted. Although CRP levels were overall lower in females, the values were not statistically significant (4.6 vs 9.9, p=0.060). No differences were noted in the proportion of patients treated with prednisone, DMARDs, biologics, or combination DMARD/Biologics among females and males (Table).
Conclusions In this routine care cohort of almost 500 PsA patients, females had worse disease activity compared to males, despite receiving the same type of medication, both in monotherapy and in combination. The reasons for this seemingly undertreament among females needs further study.
Disclosure of Interest S. Reddy *: None declared, J. Scher * Consultant for: Pfizer, Janssen, C. Swearingen: None declared, Y. Yazici Consultant for: Abbvie, BMS, Celgene, Genentech, Samumed, Pfizer, UCB