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Evaluation of the appropriateness of composite disease activity measures for assessment of psoriatic arthritis
  1. Valerie P Nell-Duxneuner1,2,
  2. Tanja A Stamm1,
  3. Klaus P Machold1,
  4. Stephan Pflugbeil3,
  5. Daniel Aletaha1,
  6. Josef S Smolen1,3
  1. 1Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
  2. 2Division of Rheumatology, Department of Medicine 4, Hanusch Hospital, Vienna, Austria
  3. 3Second Department of Medicine, Hietzing Hospital, Vienna, Austria
  1. Correspondence to Professor Josef S Smolen, Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; josef.smolen{at}


Objective Specific composite indices assessing disease activity in psoriatic arthritis (PsA) have not yet been sufficiently validated. The objective of this study was to identify instruments best reflecting disease activity in PsA.

Methods Measures for inclusion in clinical trials, as recommended by the OMERACT-7/8 PsA workshops, were assessed. A principal component analysis (PCA) was performed with cross-sectional data of 105 patients with PsA to identify a minimal set of important dimensions for a disease activity assessment tool for PsA. This was compared with components contained in existing composite indices.

Results The PCA revealed four principal components best reflecting disease activity. The first contained patient global and pain assessment; the second contained 66/68 swollen and tender joint counts as main variables; C-reactive protein (CRP) best loaded to the third component; and the fourth was loaded by skin assessment but did not reach significance. When comparing the three significant principal components with items of established composite measures, they were best covered by the Disease Activity Index for Reactive Arthritis (DAREA) which comprises patient pain and global assessments, 66/68 joint counts and CRP.

Conclusion Among the currently available indices used in arthritic conditions, the DAREA best reflects the domains found to be important in PsA.

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  • Ethics approval This study was conducted with the approval of the Medical University of Vienna.

  • Provenance and peer review Not commissioned; externally peer reviewed.