While guidelines for psoriatic arthritis recommend a treatment target of remission or low disease activity, consensus is lacking on how to define either. Disease activity is most often measured by DAPSA (Disease Activity index for Psoriatic Arthritis) score—based mainly on joints—or VLDA/MDA (very low disease activity/minimal disease activity) criteria—based on assessment of joints, skin, and entheses. Previous research indicates that remission/low disease activity rates are higher with the use of DAPSA than with VLDA/MDA, according to Laure Gossec, MD, PhD, but what measurements with either test mean to patients is not well known.
For a study published in Annals of the Rheumatic Diseases, Dr. Gossec and colleagues surveyed patients with psoriatic arthritis of more than 2 years and compared their perceptions of remissions with those of their physicians and VLDA, LDA, and DAPSA scores.
“In these patients not selected for good disease control and with usually long disease duration, remission or low disease activity were attained by more than 50% of patients,” says Dr. Gossec. “Patient-perceived remission/low disease activity was frequent (65.4%). Patient-perceived remission was as frequent as remission based on DAPSA, whereas good status according to VLDA/MDA was reached less frequently. DAPSA-based status appeared to correctly reflect patient-perceived low disease activity, which is an argument to use this score to assess psoriatic arthritis.”
As the first to compare treatment targets using composite scores and patient questions on assessment of status, the cross-sectional study used a patient questionnaire developed for this study with patient research partners, but not externally validated. Dr. Gossec also notes that whether the findings would be replicated in patients over time is unknown. She adds, though, that “physicians now have more information on patient perceptions of remission, and comparison with composite scores to follow-up patients; DAPSA appeared to agree more with patients’ assessments, though both scores have strengths and weaknesses.”
Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: an analysis of 410 patients from 14 countries