title: Patient's Global Assessment as an Outcome Measure for Psoriatic Arthritis in Clinical Practice: A Surrogate for Measuring Low Disease Activity?
abstract: OBJECTIVE
  To assess the low disease activity (LDA) in a group of patients with psoriatic arthritis (PsA) receiving antitumor necrosis factor-α (TNF-α) by using the patient's global assessment (PtGA) in clinical practice, and to compare PtGA with minimal disease activity (MDA) and other outcome measures.
  
  
  METHODS
  Patients with PsA classified by the ClASsification for Psoriatic ARthritis (CASPAR) criteria and consecutively admitted to an outpatient clinic dedicated to biologic therapy were assessed during their routine followup. The primary outcome measure was the proportion of patients achieving a PtGA ≤ 20 at 4-, 8-, and 12-month followups. Secondary outcome measures included the proportion of patients achieving MDA and other outcome measures. Correlation of PtGA with MDA and other process and outcome measures were also performed.
  
  
  RESULTS
  During the period of observation, 124 patients were evaluated. PtGA ≤ 20 was achieved in 25.7% at 4 months, 48.9% at 8 months, and 65.3% at 12 months of followup. The percentage of PtGA ≤ 20 statistically improved throughout the 3 timepoint assessments and it was statistically correlated to MDA. A significant correlation with the Disease Activity index for PSoriatic Arthritis (DAPSA), Bath Ankylosing Spondylitis Disease Activity Index, and Health Assessment Questionnaire was also observed. MDA, DAPSA, and Disease Activity Score at 28 joints with C-reactive protein remission were achieved at 12 months in 64%, 36%, and 71% of patients, respectively.
  
  
  CONCLUSIONS
  PtGA can estimate the LDA status and could be considered as a surrogate of outcome measures for the assessment of global disease activity in patients with PsA receiving anti-TNF therapy during routine clinical practice. These data suggest that PtGA might be used in outpatient settings, being a simple, reliable, and not time-consuming instrument.
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Department of Clinical and Medical Therapy, Sapienza University, Rome; Rheumatology Unit, Orthopedic Institute G. Pini, Milan, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; F.M. Perrotta, MD, Specialist Registrar, Department of Clinical and Medical Therapy, Sapienza University; W.J. Parsons, MSC, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Unit, Orthopedic Institute G. Pini. enniolubrano@hotmail.com.
authors.forename: Ennio
authors.initials: E
authors.lastname: Lubrano
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Department of Clinical and Medical Therapy, Sapienza University, Rome; Rheumatology Unit, Orthopedic Institute G. Pini, Milan, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; F.M. Perrotta, MD, Specialist Registrar, Department of Clinical and Medical Therapy, Sapienza University; W.J. Parsons, MSC, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Unit, Orthopedic Institute G. Pini.
authors.forename: Fabio Massimo
authors.initials: FM
authors.lastname: Perrotta
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Department of Clinical and Medical Therapy, Sapienza University, Rome; Rheumatology Unit, Orthopedic Institute G. Pini, Milan, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; F.M. Perrotta, MD, Specialist Registrar, Department of Clinical and Medical Therapy, Sapienza University; W.J. Parsons, MSC, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Unit, Orthopedic Institute G. Pini.
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Parsons
authors.affiliation: From the Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise, Campobasso; Department of Clinical and Medical Therapy, Sapienza University, Rome; Rheumatology Unit, Orthopedic Institute G. Pini, Milan, Italy.E. Lubrano, MD, PhD, Aggregate Professor of Rheumatology, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; F.M. Perrotta, MD, Specialist Registrar, Department of Clinical and Medical Therapy, Sapienza University; W.J. Parsons, MSC, MPH, Medical Statistician, Academic Rheumatology Unit, Department of Medicine and Health Sciences, University of Molise; A. Marchesoni, MD, Consultant Rheumatologist, Rheumatology Unit, Orthopedic Institute G. Pini.
authors.forename: Antonio
authors.initials: A
authors.lastname: Marchesoni
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000008:administration & dosage*; D015535:Arthritis, Psoriatic / Q000145:classification* / Q000188:drug therapy* / Q000503:physiopathology; D001688:Biological Products / Q000008:administration & dosage*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012008:Recurrence; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products
keywords: MINIMAL DISEASE ACTIVITY; OUTCOME MEASURES; PATIENT’S GLOBAL ASSESSMENT; PSORIATIC ARTHRITIS; REMISSION; SPONDYLOARTHROPATHIES