The "Climb" Towards Minimal Disease Activity in Psoriatic Arthritis

Area of Science:

• Rheumatology
• Clinical outcomes research
• Psoriatic arthritis management

Background:

• Minimal disease activity (MDA) is a key outcome in psoriatic arthritis (PsA), defined by a low disease activity state (cutoff 5/7).
• Understanding which domains contribute most to achieving MDA is crucial for optimizing treatment strategies.
• Previous research has focused on MDA achievement, but less on the specific domains within lower MDA cutoffs.

Purpose of the Study:

• To analyze Minimal Disease Activity (MDA) across seven different cutoffs in psoriatic arthritis (PsA) patients.
• To identify the most frequently achieved domains contributing to MDA.
• To evaluate the relationship between MDA, Patient Acceptable Symptom State (PASS), Psoriatic Arthritis Symptom Impact Disease (PsAID), Disease Activity in Psoriatic Arthritis (DAPSA), and Patient Global Health (PhGA).

Main Methods:

• A cross-sectional analysis was conducted on 93 psoriatic arthritis (PsA) patients meeting CASPAR criteria.
• Disease activity, treatment targets, function, and disease impact were assessed.
• Patients achieving MDA were compared with those not achieving MDA to determine the most frequent domains.

Main Results:

• Of 93 PsA patients, 44 achieved MDA, while 47 had MDA scores ranging from 1/7 to 4/7.
• The Leeds Enthesitis Index (LEI) was the most frequently observed domain across all patients.
• In patients not achieving MDA, Body Surface Area (BSA) ≤3% (70%) and swollen joint count ≤1 (68%) were common. Physician Global Assessment (PtGA) ≤20 and VAS pain ≤15 mm were least achieved.

Conclusions:

• Physician-assessed domains are more frequently achieved by psoriatic arthritis (PsA) patients, even those not meeting full Minimal Disease Activity (MDA).
• The Leeds Enthesitis Index (LEI) is a significant contributor to MDA status.
• These findings highlight the importance of physician-driven assessments in evaluating disease activity in PsA.