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We read with great interest the recent publication by Schoels et al1 outlining response criteria and disease state cut-offs for the disease activity in psoriatic arthritis (DAPSA) score. The DAPSA is simple and quick to perform in clinic, making it feasible for use in clinical practice, but we remain concerned about these new definitions: first, we have major concerns about the limitations of just assessing the joints in such a heterogeneous condition; second, the development of these cut-offs was done entirely based on physician opinion, without any inclusion of patients’ views; finally, there is a concern about response criteria developed almost exclusively within randomised controlled trial (RCT) datasets, which are not representative of the psoriatic arthritis (PsA) population as a whole.
As stated in the paper, the DAPSA includes a number of key outcomes designated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis/Outcomes in Rheumatology Clinical Trials group, but does not cover them all. Currently, the key outcome measures recommended are peripheral joint disease, psoriasis, pain, global disease activity, function and quality of life.2 The DAPSA covers just three of these.
This is particularly concerning when developing definitions of remission …
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