Background Remission or low disease activity should be the target of therapy in chronic inflammatory arthritis as well as in Psoariatic arthritis (PsA). In a complex disease such as PsA, several methods are available to define remission that comprise the assessment of different clinical features.
Objectives The aim of this study was to compare the composite indices tailored for PsA in both patients treated with csDMARDs and bDMARDs.
Methods Adult PsA patients classified with CASPAR criteria and with >6 months follow up treated with first csDMARDs and bDMARDs were consecutively enrolled in our outpatient clinic. To assess disease activity, composite indices tailored for PsA namely DAPSA, cDAPSA, PASDAS, MDA (5/7) and MDA (7/7) were used. DAPSA and cDAPSA score ≤4, MDA 7/7 and PASDAS ≤1.9 identified remission while MDA 5/7and PASDAS <3.2 the minimal disease activity and inactive disease criterion1–5.
Results One hundred nine PsA patients were enrolled. Of this, 79 patients were in stable treatment with bDMARDs and 30 with csDMARDs. Overall, 28 (25.6%), 23 (21.1%), 19 (17.4%), 54 (49.5%), 13 (11.9%) and 35 (32.1%) PsA patients were in cDAPSA remission, DAPSA remission, MDA 7/7, MDA 5/7, PASDAS ≤1.9 and PASDAS <3.2. Patients in bDMARDs had a significantly low median DAPSA, cDAPSA and PASDAS score than patients treated with csDMARDs (table 1). Overall, the concordance between the indices ranging from slight to good.
Conclusions PsA patients in bDMARD are more likely to reach a status of MDA and remission in respect to csDMARDs. PASDAS ≤1.9 and MDA 7/7 seem to be stringent remission criteria.
Coates LC et al. Defining disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis 2010;69:48–53.
Coates LC et al. Defining low disease activity states in psoriatic arthritis using novel composite disease instruments. J Rheumatol 2016;43:371–5.
Helliwell PS et al. The development of candidate composite disease activity and responder indices for psoriatic arthritis (GRACE project). Ann Rheum Dis 2013;72:986–91.
Schoels MM et al. Disease activity in psoriatic arthritis (PsA): defining remission and treatment success using the DAPSA score. Ann Rheum Dis 2016;75:811–8.
Nell-Duxneuner VP et al. Evaluation of the appropriateness of composite disease activity measures for assessment of psoriatic arthritis. Ann Rheum Dis 2010;69:546–49.
Disclosure of Interest None declared