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Research ArticlePsoriatic Arthritis

Comparison of Composite Indices Tailored for Psoriatic Arthritis Treated with csDMARD and bDMARD: A Cross-sectional Analysis of a Longitudinal Cohort

Ennio Lubrano, Antonia De Socio and Fabio Massimo Perrotta
The Journal of Rheumatology August 2017, 44 (8) 1159-1164; DOI: https://doi.org/10.3899/jrheum.170112
Ennio Lubrano
From the Dipartimento di Medicina e Scienze della Salute Vincenzo Tiberio, Università degli Studi del Molise, Campobasso, Italy.
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  • For correspondence: enniolubrano@hotmail.com
Antonia De Socio
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Fabio Massimo Perrotta
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    Figure 1.

    Overall rate (%) of PASDAS ≤ 1.9, PASDAS LDA, MDA 5/7, MDA 7/7, DAPSA remission, and DAPSA LDA in patients with psoriatic arthritis with > 6 months of followup treatment with bDMARD and csDMARD, according to the different definitions. PASDAS: Psoriatic Arthritis Disease Activity Score; LDA: low disease activity; MDA: minimal disease activity, DAPSA: Disease Activity Index for Psoriatic Arthritis; DMARD: disease-modifying antirheumatic drug; bDMARD: biological DMARD; csDMARD: conventional synthetic DMARD.

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    Table 1.

    Demographic and clinical disease activity characteristics in patients treated with bDMARD and csDMARD. Values are median (interquartile range) unless otherwise specified.

    CharacteristicsbDMARD, n = 79csDMARD, n = 30p
    Female/male, n38/4116/14NS
    Age, yrs, mean (SD)52.7 (12.4)51.6 (12.3)NS
    Disease duration, yrs, mean (SD)7.8 (9.3)6.6 (8.2)NS
    TJC1 (0–2)5 (2–10.2)0.0001
    SJC0 (0–1)1 (0–3.2)0.0001
    PASI0.3 (0–0.6)1.5 (0–3.2)0.02
    Patients with axial involvement, n (%)30 (37.9)5 (16.6)0.03
    Patients with active enthesitis, n (%)18 (22.7)16 (53.3)0.004
    Patients with active dactylitis, n (%)4 (5)6 (20)0.02
    CRP, mg/dl0.3 (0.16–0.49)0.3 (0.2–0.76)NS
    PASDAS3.28 (2.69–3.72)4.43 (3.73–4.76)< 0.01
    MDA 5/7, n (%)49 (62)5 (16.6)< 0.01
    MDA 7/7, n (%)16 (20.2)3 (10)NS
    DAPSA6.8 (3.7–9.57)18.1 (16.5–31.5)< 0.01
    cDAPSA6.5 (3.5–9.5)17.5 (11.2–26.9)< 0.01
    • DMARD: disease-modifying antirheumatic drug; bDMARD: biological DMARD; csDMARD: conventional synthetic DMARD; TJC: tender joint count; SJC: swollen joint count; PASI: Psoriasis Area Severity Index; CRP: C-reactive protein; PASDAS: Psoriatic Arthritis Disease Activity Score; MDA: minimal disease activity; DAPSA: Disease Activity Index for Psoriatic Arthritis; cDAPSA: clinical DAPSA; NS: not significant.

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    Table 2.

    Percentage of PASDAS ≤ 1.9, PASDAS LDA, MDA 5/7, MDA 7/7, DAPSA ≤ 4, or DAPSA LDA in patients treated with bDMARD and csDMARD therapy. Values are n (%).

    VariablesbDMARDcsDMARDp
    PASDAS ≤ 1.910 (12.6)3 (10)0.5
    PASDAS LDA33 (41.8)5 (16.6)0.02
    MDA 5/749 (62)5 (16.6)0.001
    MDA 7/716 (20.2)3 (10)0.22
    DAPSA ≤ 420 (25.3)3 (10)0.02
    cDAPSA ≤ 424 (30.4)4 (13.3)0.02
    DAPSA LDA71 (89.8)9 (30)0.0001
    cDAPSA LDA69 (87.3)10 (33.3)0.0001
    • PASDAS: Psoriatic Arthritis Disease Activity Score; LDA: low disease activity; MDA: minimal disease activity; DAPSA: Disease Activity Index for Psoriatic Arthritis; cDAPSA: clinical DAPSA; DMARD: disease-modifying antirheumatic drug; bDMARD: biological DMARD; csDMARD: conventional synthetic DMARD.

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    Table 3.

    Sensitivity and specificity of the different indices regarding physician VAS < 10 mm.

    VariablesSensitivity (95% CI)Specificity (95% CI)Likelihood Ratio
    PASDAS ≤ 1.90.33 (0.17–0.51)1 (0.95–1)—
    PASDAS LDA0.93 (0.79–0.99)0.93 (0.85–0.97)14.6
    MDA 5/70.9 (0.74–0.98)0.69 (0.57–0.79)2.9
    MDA 7/70.46 (0.29–0.65)0.96 (0.88–0.99)11.72
    DAPSA ≤ 40.65 (0.46–0.81)0.98 (0.92–0.99)49.22
    cDAPSA ≤ 40.75 (0.56–0.88)0.97 (0.9–0.99)28.13
    DAPSA LDA1 (0.89–1)0.36 (0.25–0.47)1.56
    cDAPSA LDA1 (0.89–1)0.36 (0.25–0.47)1.56
    • VAS: visual analog scale; PASDAS: Psoriatic Arthritis Disease Activity Score; MDA: minimal disease activity; DAPSA: Disease Activity Index for Psoriatic Arthritis; cDAPSA: clinical DAPSA; LDA: low disease activity.

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    Table 4.

    No. and rate of patients with PsA who achieved PASDAS ≤ 1.9, PASDAS LDA, MDA 5/7, MDA 7/7, DAPSA ≤ 4, or DAPSA LDA with residual disease activity/functional impairment in the single domains. Values are n (%).

    VariablesTJC > 1SJC > 1HAQ > 0.5PASI > 1LEI > 1
    PASDAS ≤ 1.90003 (23)0
    PASDAS LDA2 (5)1 (2.6)4 (10.5)8 (21.1)0
    MDA 5/78 (14.8)1 (1.8)3 (5.5)10 (18.5)1 (1.8)
    MDA 7/700000
    DAPSA ≤ 4002 (8.6)7 (30.4)0
    cDAPSA ≤ 4002 (7.1)7 (25)0
    DAPSA LDA24 (30)6 (7.5)22 (27.5)17 (33.7)6 (7.5)
    cDAPSA LDA23 (29.1)4 (5.1)21 (26.5)17 (21.5)5 (6.3)
    • PsA: psoriatic arthritis; PASDAS: Psoriatic Arthritis Disease Activity Score; LDA: low disease activity; MDA: minimal disease activity; DAPSA: Disease Activity Index for Psoriatic Arthritis; TJC: tender joint count; SJC: swollen joint count; HAQ: Health Assessment Questionnaire; PASI: Psoriasis Area Severity Index; LEI: Leeds Enthesitis Index; cDAPSA: clinical DAPSA.

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The Journal of Rheumatology
Vol. 44, Issue 8
1 Aug 2017
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Comparison of Composite Indices Tailored for Psoriatic Arthritis Treated with csDMARD and bDMARD: A Cross-sectional Analysis of a Longitudinal Cohort
Ennio Lubrano, Antonia De Socio, Fabio Massimo Perrotta
The Journal of Rheumatology Aug 2017, 44 (8) 1159-1164; DOI: 10.3899/jrheum.170112

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Comparison of Composite Indices Tailored for Psoriatic Arthritis Treated with csDMARD and bDMARD: A Cross-sectional Analysis of a Longitudinal Cohort
Ennio Lubrano, Antonia De Socio, Fabio Massimo Perrotta
The Journal of Rheumatology Aug 2017, 44 (8) 1159-1164; DOI: 10.3899/jrheum.170112
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Keywords

PSORIATIC ARTHRITIS
REMISSION
COMPOSITE INDICES
BIOLOGIC THERAPY
DMARD

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