The DAPSA scoring tool reflects patient-perceived low disease activity.
Introduction
Psoriatic arthritis is a chronic inflammatory disease that affects a person’s joints and other structures, including the spine, skin, and tissues joining tendons and ligaments to bones (called entheses). The disease can cause pain and mobility issues. The inflammation in psoriatic arthritis often causes swelling of the fingers, toes or bigger joints (such as the knee). It gets its name from the link between this type of arthritis and a skin condition called psoriasis, which causes skin redness and scaling.
What did the authors hope to find?
In psoriatic arthritis, the treatment target is remission (which means inactive disease), or at least low disease activity. However, there is no agreement on how to define ‘remission’ or ‘low disease activity’. Scoring tools have been developed to help assess remission and low disease activity. These include the DAPSA (short for ‘Disease Activity index for PSoriatic Arthritis’), which is based only on joints, and the VLDA/MDA (short for ‘Very Low Disease Activity/Minimal Disease Activity’), which looks at a person’s skin, entheses and joints. Both the DAPSA and VLDA/MDA scoring tools include reports from people with psoriatic arthritis about how they feel they are doing.
The authors of this study hoped to compare the different definitions of remission and low disease activity in people with psoriatic arthritis, using information from both people living with the disease, and doctors involved in treating it.
Who was studied?
The study looked at 410 people with psoriatic arthritis from 14 countries (including European countries, Singapore, Brazil, the USA and Canada). Everyone included had been diagnosed with psoriatic arthritis for more than 2 years, but there were no other rules for entry into the study. Importantly, people were not chosen based on a pre-specified level of disease activity, or what treatment they were taking.
How was the study conducted?
This was a cross-sectional study, which means that the researchers simply observed and recorded information about the people in the study once. A study of this type is used to compare different groups of people at a single point in time. After agreeing to participate, people with psoriatic arthritis completed a questionnaire. Doctors also provided information from medical records. No specific drugs or treatments were tested, and people did not have to go to any follow-up appointments.
What were the main findings of the study?
The main finding was that both remission and low disease activity were seen frequently in the 410 people with psoriatic arthritis who took part in the study. Between 12% and 36% of people achieved remission, and 25% to 47% achieved low disease activity, depending on the score used. This means that more than half of people in the study had reached the target of either remission or low disease activity.
On their questionnaires, most people with psoriatic arthritis said they had low disease activity, and thought their disease was well controlled, and this tallied with the results of the scoring tools. People were also good at identifying when they were in remission. The DAPSA score best reflected perception of remission or low disease activity by people with psoriatic arthritis, which supports the argument to use the DAPSA to assess people with psoriatic arthritis.
Are these findings new?
Yes – this is the first study to assess remission in unselected people with psoriatic arthritis from many countries. It is also the first study comparing treatment targets using the DAPSA and VLDA/MDA scores, with reports from people with psoriatic arthritis on how they feel they are doing.
What are the limitations of the study?
This was a cross-sectional study with only one questionnaire, so it is not known whether the findings would be the same if the same people were asked to answer the questions again at a later time. Another limitation is that the questions used to ask people how controlled their disease is were developed for this study and have not been validated. However, the authors are confident that they were suitable for this purpose.
What do the authors plan on doing with this information?
The information from this study will be useful for doctors and researchers working with people who have psoriatic arthritis. More research is planned to look at how and why people with psoriatic arthritis and their doctors disagree about their disease, as well as to look at fatigue, quality of life, and differences that may exist between countries.
What does this mean for me?
If you have psoriatic arthritis, there are many treatments available that can help you achieve the important targets of remission or low disease activity. Your doctor may use scoring tools and questionnaires to get a better picture of how your disease is responding to treatment, and whether you are reaching the targets, and an appropriate tool has been characterised in this study.
If you have any concerns about your disease or its treatment, you should talk to your doctor.
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Date prepared: April 2019
Summary based on research article published on: 15 November 2018
From: Gorlier C, et al. Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries.
Ann Rheum Dis 2019;78:201–208. doi:10.1136/annrheumdis-2018-214140
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