Background At present new guidelines for the therapy and monitoring of psoriatic arthritis are in progress, inspired by the EULAR guidelines 2015. We propose the Minimal Disease Activity (MDA) as a target of therapy. Given the fact that the major problem of our patients is joint manifestation of psoriatic disease (PD) and only occassionally severe skin syndrome, which usually requires different therapeutic approach we have searched for an instrument which would assess the severity of joint involvement numerically, taking into account the patient's point of view. For this purpose we used the recently validated index DAPSA1
Objectives (1) To ascertain the correlation of this index with its individual components (2) to take a look at the development of this index over time in a sample of patients from our database.
Methods We picked 53 cases out of our database of 216 patients, who had at least 6 yearly controls with full set of data available. Subsequently we calculated DAPSA according to the formula: SJC+TJC+pat.pain VAS10,0cm+pat. Global VAS10,0cm+CRPmg/l1. Then we determined the correlation between DAPSA and individual components of the index using Pearson's correlation coefficient for each of 6 controls (C). We followed further the development of this index during the course of 6 years and calculated the percentage of patients who achieved remission (REM), low disease activity (LDA), moderate disease activity (MDA), or high disease activity (HDA) according to this index. The usual treatment algorythm was used, only the more tight control was employed.
Results (1) The best correlation with DAPSA was found for CRP (0,74–0,93) and to a lesser degree for the number of swollen and tender joints (0,50–0,72 and 0,49–0,70 respectively) and for patient reported outcomes (pat. global-0,57–0,75 and pat. pain-0,44–0,61). (2) The proportion of patients in REM and LDA increased linearly during the 6-year follow up. (3) The average DAPSA score decreased during their follow-up (21,1–3,59).
Conclusions The newly validated index of disease activity DAPSA seems to be a good indicator of disease activity and treatment response in patients with psoriatic arthritis. It could be a good component of local guidelines for treatment and monitoring of PsA.
Schoels M, Aletaha D, Alasti F, et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis2015.
Acknowledgement Supported by the Research program of the Ministry of health of Czech Republic: IGA MZ CR: No. 000 000 23728
Disclosure of Interest None declared