Psoriatic arthritis
Differences in the Patient's and the Physician's Perspective of Disease in Psoriatic Arthritis

https://doi.org/10.1016/j.semarthrit.2011.12.003Get rights and content

Objective

To define the relative impact of disease components of psoriatic arthritis (PsA) on the global burden of disease and to compare physician's and patients' ratings of disease activity.

Methods

PsA patients fulfilling the Classification Criteria for Psoriatic Arthritis (N = 55) were asked for an evaluation of the absolute and relative impact of general and specific rheumatic symptoms (ie, arthritis, enthesitis, spinal disease, dactylitis), general and specific psoriatic symptoms (skin disease, nail disease), and other common symptoms (eg, fatigue). Results were related to the respective physician's evaluations of disease-related symptoms based on visual analog scale (VAS) ratings and comparative measures of disease activity (ie, swollen and tender joint counts, MASES, PASI, NAPSI).

Results

One-half of the global burden of disease in PsA patients was attributed to rheumatic symptoms with peripheral arthritis as the leading component, whereas the other one-half was equally distributed to psoriatic and additional common symptoms such as fatigue. In general, corresponding patient and physician ratings of global, rheumatic, and psoriatic disease activity showed good correlations when using VAS but at the same time revealed significantly lower ratings of the corresponding physician on VAS and transformed comparative measures (all P ≤ 0.02).

Conclusions

Although we found good correlations of various disease activity measures, physicians usually evaluated the disease activity of PsA lower than patients. These results highlight the necessity of incorporating patient reported outcome measures into the assessment of disease activity in PsA, which can easily be visualized with the help of a spiderweb graph.

Section snippets

Patients and Assessment Tools

55 PsA patients participated in the present study at the Department of Internal Medicine 3 of the University of Erlangen-Nuremberg. All patients were enrolled consecutively, met the Classification Criteria for Psoriatic Arthritis (19, 20), and were evaluated, regardless of their actual disease activity or medical history. Correspondingly, all participants were subjected to a detailed clinical examination as well as a completion of several patient-reported outcome measures consisting of 4 panels

Patients and Disease Characteristics

Our cohort consisted of 55 PsA patients, 27 of them women (mean age 51.72 ± 11.15 years; mean duration of disease 5.52 ± 5.34 years) and 28 men (mean age 51.44 ± 13.76 years; mean duration of disease 6.25 ± 7.45 years), with an overall mean age of 51.22 ± 12.21 years and an overall mean duration of disease of 5.92 ± 6.61 years. On average, our patients were evaluated to have 13 tender (12.91 ± 14.54) and 4 swollen joints (4.07 ± 4.93). The mean global pain score was 3.81 ± 2.82. Enthesial

Discussion

PsA is a complex disease with symptoms ranging from musculoskeletal disease, skin and nail disease, to systemic symptoms such as fatigue. Thus, the overall state of disease in PsA represents the sum of these individual components, their objective severity, and the way the patients experience these symptoms. Based on the complexity of PsA, the physician's evaluation of disease activity may not fully reflect the implicit burden of PsA for the patients. They may perceive and thus weigh an

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