What Should Be the Primary Target of “Treat to Target” in Psoriatic Arthritis?

Article Figures & Data

Table 1.

Complete case analysis of TICOPA.

Target	Tight Control, n (%)	Standard Care, n (%)	Chi-squared	p
DAPSA remission	35 (20.6)	15 (8.8)	8.84	0.004
cDAPSA remission	39 (22.9)	16 (9.4)	11.2	0.001
VLDA	21 (12.4)	5 (2.9)	9.94	0.002
PASDAS remission	28 (16.5)	13 (7.6)	5.50	0.021

TICOPA: Tight Control of Psoriatic Arthritis study; DAPSA: Disease Activity Index for Psoriatic Arthritis; cDAPSA: clinical DAPSA; VLDA: very low disease activity; PsA: psoriatic arthritis; PASDAS: PsA Disease Activity Score.

Table 2.

Residual disease activity in remission and VLDA definitions for 170 patients with full data in the TICOPA trial.

		DAPSA Remission	cDAPSA Remission	VLDA	PASDAS Remission
Patients Fulfilling the Criteria		50 (29.4)	55 (32.4)	26 (15.2)	41 (24.1)
PASDAS	Mean (SD)	1.63 (0.70)	1.71 (0.71)	1.47 (0.68)	1.35 (0.50)
Tender joint count	0	39 (78.0)	39 (70.9)	20 (76.9)	28 (68.3)
	1	8 (16.0)	11 (20.0)	6 (23.1)	6 (14.6)
	2	3 (6.0)	5 (9.1)	0 (0)	3 (7.3)
	3	0 (0)	0 (0)	0 (0)	1 (2.4)
	4	0 (0)	0 (0)	0 (0)	2 (4.9)
	7	0 (0)	0 (0)	0 (0)	1 (2.4)
Swollen joint count	0	45 (90.0)	47 (85.5)	25 (96.2)	35 (85.4)
	1	2 (4.0)	4 (7.3)	1 (3.8)	3 (7.3)
	2	3 (6.0)	4 (7.3)	0 (0)	2 (4.9)
	5	0 (0)	0 (0)	0 (0)	1 (2.4)
Enthesitis count	0	42 (84)	45 (81.8)	25 (96.2)	34 (82.9)
	1	3 (6)	3 (5.5)	1 (3.8)	2 (4.9)
	2	3 (6)	5 (9.1)	0 (0)	3 (7.3)
	3	1 (2)	1 (1.8)	0 (0)	1 (2.4)
Dactylitis count	0	46 (92)	51 (92.7)	24 (92.3)	40 (97.6)
	1	1 (2.0)	1 (1.8)	1 (3.8)	1 (2.4)
	2	2 (4.0)	2 (3.6)	1 (3.8)	0 (0)
	3	1 (2.0)	1 (1.8)	0 (0)	0 (0)
PASI	0	22 (44)	24 (43.6)	15 (57.7)	23 (56.1)
	0.1–1.0	11 (22)	12 (21.8)	11 (42.3)	9 (22.0)
	1.1–3.0	11 (22)	11 (20.0)	0 (0)	6 (14.6)
	3.1–5.0	5 (10)	6 (10.9)	0 (0)	2 (4.8)
	> 5	1 (2.0)	2 (3.6)	0 (0)	1 (2.4)
CRP	Normal, < 5 mg/dl	37 (74)	40 (72.7)	19 (73.1)	31 (75.6)
CRP	Raised	13 (26)	15 (27.2)	7 (26.9)	10 (24.4)
Pt global VAS	≤ 20 mm, > 20 mm	50 (100), 0 (0)	55 (100), 0 (0)	26 (100), 0 (0)	40 (98), 1 (2)
Pt pain VAS	≤ 15 mm, > 15 mm	50 (100), 0 (0)	55 (100), 0 (0)	26 (100), 0 (0)	38 (93), 3 (7)
HAQ	≤ 0.5, > 0.5	50 (100), 0 (0)	53 (96), 2 (4)	26 (100), 0 (0)	41 (100), 0 (0)

Data are n (%), except where indicated. TICOPA: Tight Control of Psoriatic Arthritis study; CRP: C-reactive protein; DAPSA: Disease Activity in Psoriatic Arthritis; HAQ: Health Assessment Questionnaire, PASI: Psoriasis Area and Severity Index; PASDAS: Psoriatic Arthritis Disease Activity Score; VAS: visual analog scale; VLDA: very low disease activity; cDAPSA: clinical DAPSA.

Table 3.

Residual disease activity in remission and VLDA definitions in real-life dataset.

		DAPSA Remission	cDAPSA Remission	VLDA	PASDAS Remission
Patients Fulfilling the Criteria		18 (22.8)	22 (27.8)	15 (19.0)	13 (16.5)
PASDAS	Mean (SD)	1.45 (0.76)	1.66 (0.87)	1.68 (0.98)	1.06 (0.45)
Tender joint count	0	13 (72.2)	16 (72.7)	9 (60)	13 (100)
	1	5 (27.6)	6 (27.3)	6 (40)	0
	2	0	0	0	0
Swollen joint count	0	17 (94.5)	21 (95.4)	14 (93.3)	12 (92)
	1	1 (5.5)	1 (4.5)	1 (6.7)	1 (8)
	2	0	0	0	0
Enthesitis count	0	17 (94.5)	19 (86.3)	13 (86.7)	11 (85)
	1	1 (5.5)	2 (9.0)	2 (13.3)	2 (15)
	2	0	1 (4.5)	0	0
PASI	0–0.3	11 (61.1)	14 (63.6)	12 (80)	9 (69)
	0.4–0.6	2 (11.1)	2 (9.0)	2 (13.3)	1(8)
	0.7–1	0	1 (4.5)	1 (6.7)	0
	> 1	5 (27.7)	5 (22.7)	0	3 (23)
CRP	Normal, < 5 mg/dl	17 (94.4)	20 (91)	14 (93.3)	13 (100)
CRP	Raised	1 (5.5)	2 (9.0)	1 (6.7)	0
Pt global VAS	≤ 20 mm, > 20 mm	18 (100), 0 (0)	22 (100), 0 (0)	15 (100), 0 (0)	13 (100), 0 (0)
Pt pain VAS	≤ 15 mm, > 15 mm	18 (100), 0 (0)	20 (90.9), 2 (9.1)	15 (100), 0 (0)	13 (100), 0 (0)
HAQ	≤ 0.5, > 0.5	17 (94.5), 1 (5.5)	20 (90.9), 2 (9.1)	15 (100), 0 (0)	13 (100), 0 (0)

Data are n (%), except where indicated. CRP: C-reactive protein; DAPSA: Disease Activity in Psoriatic Arthritis; cDAPSA: clinical DAPSA; HAQ: Health Assessment Questionnaire; PASI: Psoriasis Area and Severity Index; PASDAS: Psoriatic Arthritis Disease Activity Score; VAS: visual analog scale; VLDA: very low disease activity.

Table 4.

Comparison of individual measures contained in the composite targets.

	DAPSA	cDAPSA	VLDA	PASDAS
TJC	Yes	Yes	Yes	Yes
SJC	Yes	Yes	Yes	Yes
Pt global VAS	Yes	Yes	Yes	Yes
Pt pain VAS	Yes	Yes	Yes	No
CRP	Yes	No	No	Yes
Enthesitis	No	No	Yes	Yes
Psoriasis rash	No	No	Yes	No
HAQ	No	No	Yes	No
Dactylitis	No	No	No	Yes
Physician’s global VAS	No	No	No	Yes
SF-36 PCS	No	No	No	Yes

DAPSA: Disease Activity in Psoriatic Arthritis; cDAPSA: clinical DAPSA; VLDA: very low disease activity; PASDAS: Psoriatic Arthritis Disease Activity Score; TJC: tender joint count; SJC: swollen joint count; VAS: visual analog scale; CRP: C-reactive protein; HAQ: Health Assessment Questionnaire; SF-36: Medical Outcomes Study Short Form-36 questionnaire; PCS: SF-36 physical component summary.