Background PsA is a chronic inflammatory arthritis with heterogeneous clinical manifestations. Disease burden and quality of life (QoL) is affected by both joint and skin aspects of the disease (1,2). Given variability among patients of the extent and severity of joint and skin symptoms, the relative impact of each aspect on overall burden to the patient has not been well quantified.
Objectives Describe the relative impact of joint and skin symptoms in PsA in a real-world population through an assessment of patient perception of symptom importance, QoL, and work productivity.
Methods Cross-sectional survey of rheumatologists and dermatologists and their PsA patients in australia, Canada, France, Germany, Italy, Japan, Spain, UK, and US. Physicians provided data on patient Body Surface area (BSA) psoriasis coverage at the time of survey. Patient self-reported data included perceptions of symptom importance, EQ-5D, Psoriatic arthritis Impact of Disease (PsAID12), and Work Productivity and activity Impairment (WPAI: SHP) index. Patients were compared according to BSA (BSA=0 vs. BSA>0), using parametric and non-parametric tests as appropriate.
Results Data were collected for 3200 patients with PsA by 454 rheumatologists and 238 dermatologists. 556 patient self-completed questionnaires were also collected. Mean age was 49 years, 46% female, 69% had a BSA>0. Patients with BSA>0 had mean tender joint count (TJC) of 5.2 and mean swollen joint count (SJC) of 4.8. Patients with BSA=0 had mean TJC and SJC of 2.0 and 1.5, respectively.
Across all patients, when asked to prioritize the burden of symptoms, 62% of patients prioritized joints and 38% prioritized skin. In patients with BSA=0, 35% still prioritized skin as most important. 41% indicated they experienced anxiety/depression as a result of their PsA, with 62% indicating both joint and skin symptoms were the cause (28% joint alone, 9% skin alone).
Patients with BSA >0 reported significantly worse QoL and work productivity and activity impairment than BSA=0 (EQ5D index 0.79 vs. 0.85, p<0.0001; EQ5D VAS 71.98 vs. 77.68, p<0.0001; PsAID 2.91 vs. 1.66, p<0.0001; WPAI overall 25.61 vs. 16.32, p<0.0001).
Conclusion The majority of PsA patients prioritise joint symptoms over skin. Patients with any joint/skin involvement likely have worse quality of life than in the general population (3). PsA patients report that both joints and skin have an impact on their QoL and work productivity with significantly greater impact in those who have skin involvement. Treatment goals focusing on both components of PsA would optimize patient outcomes.
References  Mease PJ. Biologic therapy for Psoriatic arthritis. Rheum Dis Clin North am. 2015;41(4):723–38.
 Sokoll KB, Helliwell PS. Comparison of disability and quality of life in rheumatoid and psoriatic arthritis. J Rheumatol. 2001 aug 1;28(8):1842 LP-1846.
 Hanmer J, et al. Report of Nationally Representative Values for the Noninstitutionalized US adult Population for 7 Health-Related Quality-of-Life Scores. Med Decis Mak. 2006 Jul 1;26(4):391–400.
Disclosure of interests William Tillett Grant/research support from: abbVie, Celgene, and Lilly, Consultant for: abbVie, Celgene, Lilly, Novartis, and Pfizer, Speakers bureau: abbvie, Celgene, Lilly, Janssen, Novartis, UCB, and Pfizer, Joseph F. Merola Consultant for: Biogen IDEC, abbvie, amgen, Eli Lilly and Company, Novartis, Pfizer, Janssen, UCB, Samumed, Celgene, Sanofi Regeneron, Merck, and GSK, Diamant Thaçi Grant/research support from: abbVie, almirall, amgen, Bio Skin, Biogen-Idec, Boehringer ingelheim, Bristol-Myers Squibb, Celgene, Chugai, Dermira, Dignity, Eli Lilly, forward Pharma, GlaxoSmithKline, Janssen Cilag, Leo Pharma, Novartis, Pfizer, Regeneron, Roche, Sandoz-Hexal, Sanofi, and UCB, Consultant for: abbVie, almirall, Bristol-Myers Squibb, Celgene, Dignity, Galapagos, Leo Pharma, Lilly, Novartis, Pfizer, and UCB; honoraria: abbVie, almirall, amgen, Bio Skin, Celgene, Dignity, Janssen, Leo Pharma, Merck Sharp & Dohme, Novartis, Pfizer, Roche-Posay, Sandoz-Hexal, Sanofi, and USB; advisory board: abbVie, Bio Skin, Bristol-Myers Squibb, Celgene, Dignity, Eli Lilly, Galapagos, GlaxoSmithKline, Janssen Cilag, Leo Pharma, Morphosis, Novartis, Pfizer, Sandoz, Sanofi, and UCB, Nicola Booth Employee of: adelphi Real World, Steve Lobosco Employee of: adelphi Real World, Gary Milligan Employee of: adelphi Real World, Matthew Hufford Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Julie Birt Shareholder of: Eli Lilly and Company, Employee of: Eli Lilly and Company, Wolf-Henning Boehncke Consultant for: Pfizer inc, Speakers bureau: Pfizer inc, Elizabeth Holdsworth Employee of: adelphi Real World
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