Background Psoriatic Arthritis (PsA) and Psoriasis (PsO), have a significant impact on health-related quality of life and work productivity loss. In patients with both PsA and PsO, the full extent of the physical and emotional burden due to either joint related or skin related symptoms is not well understood from the perspective of the patient.
Objectives To evaluate the patients’ perspective on the overall burden of skin and joint related symptoms of PsA in a cross-sectional online survey.
Methods A 20 min web based survey was developed based on analysis of 1-on-1 interviews with 30 PsA patients from the US, France and Germany. The final survey contained validated instruments including the PSA Quality of Life (PSAQoL) and Work Productivity and Activity Impairment (WPAI) questionnaires as well as custom questions designed to capture emotional burden of PsA and its impact on daily activities/situations. Additional data collected included demographics, severity of PsO by patient-reported body surface area involvement (BSA), severity of PsA by RAPID3, impact of PsO and PsA by a Patient Global Assessment scale with focus on skin or joint symptoms. In total, 439 psoriatic arthritis (PsA) patients from the US (68%), Germany (20%) and France (12%) were recruited to complete the survey.
Results Among all participants, 30% had mild and 70% had mod-severe PsA based on RAPID-3 cutoffs, while 51% had mild and 48% had mod-severe PsO based on BSA cutoffs. According to multiple regression analyses, severity of joint symptoms and skin symptoms were signifcantly associated with lower PsAQoL (p<0.0001) as was age (p<0.0001). In patients with mild joint severity, impact of skin symptoms was significantly associated with PsAQoL (p<0.0001) as well as age and gender (p<0.05). Joint severity and impact of joint symptoms were the strongest contributors to the WPAI scores (p<0.05). When asked to select the 2 emotions most associated with the impact of their joint symptoms, patients most often chose fatigue (36%), worry/concern (19%) and depression (17%), and with respect to their skin symptoms, patients most often chose embarrassment (24%), fatigue (23%), worry/concern (14%) and depression (12%). When asked to rate the impact of their disease in certain scenarios or situations, more than 25% of patients reported that their joint symptoms had a severe impact (a choice of 8, 9 or 10 on a 10-point scale with 0=no impact and 10=severe) on fatigue (32%) “leisure activities” (26%), “how they think of themselves” (25%) and “how others felt about them” (26%). More than 25% of patients reported that their skin symptoms had a severe impact on fatigue (28%) “how they think of themselves” (27%),“how others thought of them” (27%) and “making a first impression” (28%).
Conclusions In this survey of patients with PsA, we evaluated the patient‘s perspective on the burden of both skin-related and joint-related symptoms with the PsAQoL and WPAI as well as with a set of novel questions. Both skin and joint symptoms have a broad and meaningful impact on patient QoL, work productivity and patients reported a range of emotions as well as a variety of impacts on their daily activities with respect to skin and joint symptoms. This data highlights that there is a unique impact of PsA for each patient.
Disclosure of Interest J. Merola Grant/research support from: Amgen; Biogen Idec, Boehringer Ingelheim, Pfizer, Consultant for: Abbvie, Amgen, Biogen Idec, Celgene, Eli Lilly and Company, GlaxoSmithKline, Janssen, Kiniksa Pharmaceuticals, Mallingkrodt, Merck, Momenta, Novartis, Pfizer, Samumed, Sanofi, Science37, and UCB, D. Shrom Shareholder of: Eli Lilly and Co, Employee of: Eli Lilly and Co, J. Eaton Shareholder of: Eli Lilly and Co, Employee of: Eli Lilly and Co, C. Dworkin: None declared, C. Kresbach: None declared, B. Shah-Manek: None declared, J. Birt Shareholder of: Eli Lilly and Co, Employee of: Eli Lilly and Co
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