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

doi:10.3899/jrheum.170112

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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.

Characteristics	bDMARD, n = 79	csDMARD, n = 30	p
Female/male, n	38/41	16/14	NS
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
TJC	1 (0–2)	5 (2–10.2)	0.0001
SJC	0 (0–1)	1 (0–3.2)	0.0001
PASI	0.3 (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/dl	0.3 (0.16–0.49)	0.3 (0.2–0.76)	NS
PASDAS	3.28 (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
DAPSA	6.8 (3.7–9.57)	18.1 (16.5–31.5)	< 0.01
cDAPSA	6.5 (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 (%).

Variables	bDMARD	csDMARD	p
PASDAS ≤ 1.9	10 (12.6)	3 (10)	0.5
PASDAS LDA	33 (41.8)	5 (16.6)	0.02
MDA 5/7	49 (62)	5 (16.6)	0.001
MDA 7/7	16 (20.2)	3 (10)	0.22
DAPSA ≤ 4	20 (25.3)	3 (10)	0.02
cDAPSA ≤ 4	24 (30.4)	4 (13.3)	0.02
DAPSA LDA	71 (89.8)	9 (30)	0.0001
cDAPSA LDA	69 (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.

Variables	Sensitivity (95% CI)	Specificity (95% CI)	Likelihood Ratio
PASDAS ≤ 1.9	0.33 (0.17–0.51)	1 (0.95–1)	—
PASDAS LDA	0.93 (0.79–0.99)	0.93 (0.85–0.97)	14.6
MDA 5/7	0.9 (0.74–0.98)	0.69 (0.57–0.79)	2.9
MDA 7/7	0.46 (0.29–0.65)	0.96 (0.88–0.99)	11.72
DAPSA ≤ 4	0.65 (0.46–0.81)	0.98 (0.92–0.99)	49.22
cDAPSA ≤ 4	0.75 (0.56–0.88)	0.97 (0.9–0.99)	28.13
DAPSA LDA	1 (0.89–1)	0.36 (0.25–0.47)	1.56
cDAPSA LDA	1 (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 (%).

Variables	TJC > 1	SJC > 1	HAQ > 0.5	PASI > 1	LEI > 1
PASDAS ≤ 1.9	0	0	0	3 (23)	0
PASDAS LDA	2 (5)	1 (2.6)	4 (10.5)	8 (21.1)	0
MDA 5/7	8 (14.8)	1 (1.8)	3 (5.5)	10 (18.5)	1 (1.8)
MDA 7/7	0	0	0	0	0
DAPSA ≤ 4	0	0	2 (8.6)	7 (30.4)	0
cDAPSA ≤ 4	0	0	2 (7.1)	7 (25)	0
DAPSA LDA	24 (30)	6 (7.5)	22 (27.5)	17 (33.7)	6 (7.5)
cDAPSA LDA	23 (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.