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Extended report
Ideal target for psoriatic arthritis? Comparison of remission and low disease activity states in a real-life cohort
  1. Leonieke J J van Mens1,
  2. Marleen G H van de Sande1,
  3. Arno W R van Kuijk2,
  4. Dominique Baeten1,
  5. Laura C Coates3
  1. 1 Clinical Immunology & Rheumatology, Amsterdam Rheumatology and Immunology Center, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
  2. 2 Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands
  3. 3 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
  1. Correspondence to Dr Laura C Coates, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research CentreWindmill Road, Oxford, OX3 7LD, UK; laura.coates{at}


Background Psoriatic arthritis (PsA) recommendations state that the target of treatment should be remission or low disease activity (LDA). We used a real-life dataset to compare different potential targets.

Methods 250 patients with PsA considered in an acceptable disease state according to their rheumatologist were included. Targets for remission were the Disease Activity Index for Psoriatic Arthritis (DAPSA) and clinical DAPSA (cDAPSA) remission (≤4), very low disease activity (VLDA) and Psoriatic Arthritis Disease Activity Score ≤1.9. LDA targets analysed were the DAPSA ≤14, cDAPSA ≤13, minimal disease activity (MDA) and adjusted MDA targets: MDAjoints with both tender joint count (TJC) and swollen joint count (SJC) mandated, MDAskin (psoriasis area and severity index (PASI) mandated) and MDAjoints&skin with TJC, SJC and PASI mandated.

Results Comparison of the several candidate targets demonstrates that VLDA is achieved by the lowest proportion of patients and includes patients with the lowest residual disease activity compared with the other remission targets. The modified MDA measures are the most stringent targets for LDA in terms of residual disease on joints, psoriasis and enthesitis within patients achieving the target. In both remission and LDA, the inclusion of C reactive protein did not show an added value. The exclusion of a skin domain, as in the DAPSA measures, resulted in negligence of skin disease and a negative impact on the quality of life in some patients.

Conclusions The different remission and LDA targets show us significant overlap between measures, but these measures targeting the same definition do differ in terms of allowance of residual disease. Inclusion of laboratory markers seems unnecessary, although exclusion of a skin domain may result in psoriasis not being assessed resulting in residual impactful skin disease.

  • psoriatic arthritis
  • outcomes research
  • disease activity

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  • Handling editor Tore K Kvien

  • Contributors All authors fulfilled the ICMJE recommendations for authorship, were involved in drafting and reviewing of the manuscript and approved the final version.

  • Funding The original cohort was supported by an unrestricted grant from Pfizer B.V.

  • Competing interests LJJvM, none declared. MGHvdS has received speakers/consultancy fees from Takeda, Tillotts and Benecke MSD. DB has received research grants and speakers/consultancy fees from Pfizer, MSD, AbbVie, UCB, Novartis, Janssen, Boehringer Ingelheim; speakers/consultancy fees from Eli Lilly, Roche, BMS and Glenmark; and is currently an employee of UCB. AWRvK has received speakers/consultancy fees from Celgene, Janssen-Cilag, Novartis, MSD and Roche. LCC, none declared.

  • Patient consent Obtained.

  • Ethics approval METC AMC Amsterdam.

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