Comparison of Different Remission and Low Disease Definitions in Psoriatic Arthritis and Evaluation of Their Prognostic Value

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Figure 1.
Proportion of patients achieving each definition in the 2 treatment groups. A. Patients receiving ETN 50 mg QW/QW achieving remission. B. Patients receiving ETN 50 mg BIW/QW achieving remission. C. Patients receiving ETN 50 mg QW/QW achieving LDA. D. Patients receiving ETN 50 mg BIW/QW achieving LDA. * p < 0.05 indicates a significant difference between ETN 50 mg QW and ETN 50 mg BIW within the LDA definition specified. ETN: etanercept; QW: once weekly; BIW: twice weekly; LDA: low disease activity; VLDA: very LDA; DAPSA: Disease Activity Index for Psoriatic Arthritis; cDAPSA: clinical DAPSA; MDA: minimal disease activity.

Table 1.

Remission and low disease activity definitions investigated.

↵* PtGA VAS of the maximum component either of psoriasis activity (0–100) or of arthritis activity (0–100).
↵^ PtGA VAS of arthritis activity (0–100)/10. LDA: low disease activity; VLDA: very LDA; DAPSA: Disease Activity Index for Psoriatic Arthritis; cDAPSA: clinical DAPSA; MDA: minimal disease activity; TJC: tender joint count; SJC: swollen joint count; PASI: Psoriasis Area and Severity Index; PtGA VAS: patient visual analog scale; HAQ: Health Assessment Questionnaire; CRP: C-reactive protein.

Table 2.

Proportion of patients with residual disease at Week 24 across each remission definition.

Variables	VLDA Remission	DAPSA Remission	cDAPSA Remission	DAPSA Remission+ VLDA Remission−^*
Dactylitis (1–3)	2/68 (2.9)	5/231 (2.2)	5/250 (2.0)	3/166 (1.8)
Enthesitis (3)	0/68 (0.0)	1/232 (0.4)	1/251 (0.4)	1/167 (0.6)
HAQ score > 0.5	0/68 (0.0)	15/231 (6.5)	17/250 (6.8)	15/166 (9.0)
PASI score 0	47/68 (69.1)	54/232 (23.3)	58/251 (23.1)	8/167 (4.8)
PASI score 1	21/68 (30.9)	50/232 (21.6)	53/251 (21.1)	31/167 (18.6)
PASI score 2–9	0/68 (0.0)	114/232 (49.1)	123/251 (49.0)	114/167 (68.3)
PASI score ≥ 10	0/68 (0.0)	14/232 (6.0)	17/251 (6.8)	14/167 (8.4)
SJC > 1	0/68 (0.0)	7/232 (3.0)	9/251 (3.6)	7/167 (4.2)
TJC > 1	0/68 (0.0)	7/232 (3.0)	9/251 (3.6)	7/167 (4.2)
CRP (ULN > 8.99 mg/dl)	5/67 (7.5)	14/232 (6.0)	22/248 (8.9)	10/167 (6.0)

Values are n/N (%).
↵* Frequency of residual disease for patients who met DAPSA but not VLDA remission at Week 24. VLDA: very low disease activity; DAPSA: Disease Activity for Psoriatic Arthritis; cDAPSA: clinical DAPSA; HAQ: Health Assessment Questionnaire; PASI: Psoriasis Area and Severity Index; SJC: swollen joint count; TJC: tender joint count; CRP: C-reactive protein; ULN: upper limit of normal.

Table 3.

Proportion of patients in discordance for each pair of LDA definitions at Week 24.

LDA Definition 1	LDA Definition 2	Proportion of Patients Achieving LDA 2 but Not LDA 1, n/N (%)	Proportion of Patients Achieving LDA 1 but Not LDA 2, n/N (%)	κ Coefficient^*
MDA 5/7	DAPSA LDA	184/669 (27.5)	10/669 (1.5)	0.45
MDA skin	DAPSA LDA	346/668 (51.8)	7/668 (1.0)	0.15
MDA joint	DAPSA LDA	225/668 (33.7)	1/665 (0.1)	0.39
MDA joint + skin	DAPSA LDA	373/669 (55.8)	1/669 (0.1)	0.13
MDA 5/7	cDAPSA LDA	183/676 (27.1)	10/676 (1.5)	0.45
MDA skin	cDAPSA LDA	347/675 (51.4)	7/675 (1.0)	0.16
MDA joint	cDAPSA LDA	225/675 (33.3)	1/675 (0.1)	0.40
MDA joint + skin	cDAPSA LDA	375/676 (55.5)	1/676 (0.1)	0.13

↵* From κ test of agreement between LDA definition 1 and definition 2. LDA: low disease activity; MDA: minimal disease activity; DAPSA: Disease Activity for Psoriatic Arthritis; cDAPSA: clinical DAPSA.

Table 4.

Proportion of patients with residual disease across each LDA definition at Week 24.

Variables	MDA 5/7	MDA Skin	MDA Joint	MDA Joint + Skin	DAPSA LDA	cDAPSA LDA
Dactylitis (1–12)	8/300 (2.7)	5/129 (3.9)	5/247 (2.0)	3/97 (3.1)	20/466 (4.3)	19/469 (4.1)
Enthesitis (1–5)	2/302 (0.7)	2/130 (1.5)	1/248 (0.4)	1/97 (1.0)	16/468 (3.4)	16/471 (3.4)
PASI score 0	83/302 (27.5)	82/130 (63.1)	63/248 (25.4)	63/97 (64.9)	100/468 (21.4)	100/471 (21.2)
PASI score 1	76/302 (25.2)	48/130 (36.9)	58/248 (23.4)	34/97 (35.1)	96/468 (20.5)	100/471 (21.2)
PASI score 2–9	130/302 (43.0)	0/130 (0.0)	116/248 (46.8)	0/97 (0.0)	234/468 (50.0)	232/471 (49.2)
PASI score ≥ 10	13/302 (4.3)	0/130 (0.0)	11/248 (4.4)	0/97 (0.0)	38/468 (8.1)	39/471 (8.3)
TJC > 1	43/302 (14.2)	28/130 (21.5)	0/248 (0.0)	0/97 (0.0)	137/468 (29.3)	135/471 (28.7)
SJC > 1	17/302 (5.6)	14/130 (10.8)	0/248 (0.0)	0/97 (0.0)	64/468 (13.7)	62/471 (13.2)

Values are n/N (%). LDA: low disease activity; MDA: minimal disease activity; DAPSA: Disease Activity for Psoriatic Arthritis; cDAPSA: clinical DAPSA; PASI: Psoriasis Area and Severity Index; TJC: tender joint count; SJC: swollen joint count.