Need for Improvement in Current Treatment of Psoriatic Arthritis: Study of an Outpatient Clinic Population.
To explore the burden of skin, joint, and entheses manifestations in a representative psoriatic arthritis (PsA) outpatient cohort in the biologic treatment era.



This was a cross-sectional study of 141 PsA outpatients fulfilling the ClASsification for Psoriatic ARthritis (CASPAR) criteria and examined between January 2013 and May 2014. Selected disease activity measures were explored including Disease Activity index for PSoriatic Arthritis (DAPSA), Composite Psoriatic Disease Activity Index (CPDAI), Psoriatic Arthritis Disease Activity Score (PASDAS), Disease Activity Score for 28 joints (DAS28), Simplified Disease Activity Index (SDAI), and Psoriasis Area Severity Index (PASI). Dermatology Life Quality Index (DLQI), minimal disease activity (MDA), and remission criteria were assessed.



Median (range) DAPSA was 14.5 (0.1-76.4), CPDAI 5 (1-11), PASDAS 3.1 (2.1-4.2), DAS28-erythrocyte sedimentation rate (ESR) 3.2 (0.6-6.4), SDAI 8.6 (0.1-39.5), PASI 1.2 (0.0-19.7), and DLQI 2.0 (0-17). The MDA criteria were fulfilled by 22.9% of the patients. DAPSA ≤ 4, CPDAI ≤ 2, PASDAS < 2.4, DAS28-ESR < 2.4, SDAI < 3.3, and Boolean's remission criteria were fulfilled by 12.1, 9.3, 7.8, 26.2, 21.3, and 5.7% of patients, respectively. The number of satisfied patients was similar regardless of whether the group was treated with tumor necrosis factor inhibitors.



Our real-life data indicate that there is still a need for improvement in today's treatment of PsA. Musculoskeletal inflammatory involvement was more prominent than psoriatic skin involvement. Only a few patients fulfilled the DAPSA, PASDAS, and CPDAI remission criteria, and about a quarter fulfilled the MDA criteria. Considerably fewer patients fulfilled PsA-specific remission criteria versus non-PsA specific remission criteria. Still, patient satisfaction was good and PASI and DLQI were low.
From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway; Division of Rheumatology, Allergy, Immunology, University of California at San Diego, San Diego, California, USA; Department of Rheumatology, Martina Hansens Hospital, Bærum; Norwegian University of Science and Technology, Trondheim, Norway. brigitte_michelsen@yahoo.no.|B. Michelsen, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A.P. Diamantopoulos, PhD, Department of Rheumatology, Haugesund Rheumatism Hospital; H.K. Høiberg, MD, Department of Rheumatology, Hospital of Southern Norway Trust; D.M. Soldal, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A. Kavanaugh, PhD, Division of Rheumatology, Allergy, Immunology, University of California at San Diego; G. Haugeberg, PhD, Department of Rheumatology, Hospital of Southern Norway Trust, and Department of Rheumatology, Martina Hansens Hospital, and Norwegian University of Science and Technology. brigitte_michelsen@yahoo.no.
Brigitte
B
Michelsen
From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway; Division of Rheumatology, Allergy, Immunology, University of California at San Diego, San Diego, California, USA; Department of Rheumatology, Martina Hansens Hospital, Bærum; Norwegian University of Science and Technology, Trondheim, Norway.|B. Michelsen, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A.P. Diamantopoulos, PhD, Department of Rheumatology, Haugesund Rheumatism Hospital; H.K. Høiberg, MD, Department of Rheumatology, Hospital of Southern Norway Trust; D.M. Soldal, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A. Kavanaugh, PhD, Division of Rheumatology, Allergy, Immunology, University of California at San Diego; G. Haugeberg, PhD, Department of Rheumatology, Hospital of Southern Norway Trust, and Department of Rheumatology, Martina Hansens Hospital, and Norwegian University of Science and Technology.
Andreas P
AP
Diamantopoulos
From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway; Division of Rheumatology, Allergy, Immunology, University of California at San Diego, San Diego, California, USA; Department of Rheumatology, Martina Hansens Hospital, Bærum; Norwegian University of Science and Technology, Trondheim, Norway.|B. Michelsen, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A.P. Diamantopoulos, PhD, Department of Rheumatology, Haugesund Rheumatism Hospital; H.K. Høiberg, MD, Department of Rheumatology, Hospital of Southern Norway Trust; D.M. Soldal, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A. Kavanaugh, PhD, Division of Rheumatology, Allergy, Immunology, University of California at San Diego; G. Haugeberg, PhD, Department of Rheumatology, Hospital of Southern Norway Trust, and Department of Rheumatology, Martina Hansens Hospital, and Norwegian University of Science and Technology.
Hege Kilander
HK
Høiberg
From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway; Division of Rheumatology, Allergy, Immunology, University of California at San Diego, San Diego, California, USA; Department of Rheumatology, Martina Hansens Hospital, Bærum; Norwegian University of Science and Technology, Trondheim, Norway.|B. Michelsen, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A.P. Diamantopoulos, PhD, Department of Rheumatology, Haugesund Rheumatism Hospital; H.K. Høiberg, MD, Department of Rheumatology, Hospital of Southern Norway Trust; D.M. Soldal, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A. Kavanaugh, PhD, Division of Rheumatology, Allergy, Immunology, University of California at San Diego; G. Haugeberg, PhD, Department of Rheumatology, Hospital of Southern Norway Trust, and Department of Rheumatology, Martina Hansens Hospital, and Norwegian University of Science and Technology.
Dag Magnar
DM
Soldal
From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway; Division of Rheumatology, Allergy, Immunology, University of California at San Diego, San Diego, California, USA; Department of Rheumatology, Martina Hansens Hospital, Bærum; Norwegian University of Science and Technology, Trondheim, Norway.|B. Michelsen, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A.P. Diamantopoulos, PhD, Department of Rheumatology, Haugesund Rheumatism Hospital; H.K. Høiberg, MD, Department of Rheumatology, Hospital of Southern Norway Trust; D.M. Soldal, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A. Kavanaugh, PhD, Division of Rheumatology, Allergy, Immunology, University of California at San Diego; G. Haugeberg, PhD, Department of Rheumatology, Hospital of Southern Norway Trust, and Department of Rheumatology, Martina Hansens Hospital, and Norwegian University of Science and Technology.
Arthur
A
Kavanaugh
From the Department of Rheumatology, Hospital of Southern Norway Trust, Kristiansand; Department of Rheumatology, Haugesund Rheumatism Hospital, Haugesund, Norway; Division of Rheumatology, Allergy, Immunology, University of California at San Diego, San Diego, California, USA; Department of Rheumatology, Martina Hansens Hospital, Bærum; Norwegian University of Science and Technology, Trondheim, Norway.|B. Michelsen, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A.P. Diamantopoulos, PhD, Department of Rheumatology, Haugesund Rheumatism Hospital; H.K. Høiberg, MD, Department of Rheumatology, Hospital of Southern Norway Trust; D.M. Soldal, MD, Department of Rheumatology, Hospital of Southern Norway Trust; A. Kavanaugh, PhD, Division of Rheumatology, Allergy, Immunology, University of California at San Diego; G. Haugeberg, PhD, Department of Rheumatology, Hospital of Southern Norway Trust, and Department of Rheumatology, Martina Hansens Hospital, and Norwegian University of Science and Technology.
Glenn
G
Haugeberg
D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000175:diagnosis* / Q000188:drug therapy*; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D011788:Quality of Life; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
DISEASE BURDEN; PSORIATIC ARTHRITIS; REMISSION