Comparison of Composite Measure Remission Targets in Psoriatic Arthritis.
To identify 1) which composite measure is the most stringent target of remission; and 2) which disease component target proves the most difficult to achieve in the different states of MDA, CPDAI, DAPSA and cDAPSA in patients with PsA.258 PsA patients were recruited. Disease remission was evaluated comparing 4 different composite measures and using remission cut-offs as previously proposed (VLDA (MDA 7/7), CPDAI ≤2, DAPSA ≤4, cDAPSA ≤4).Patients met VLDA criteria in 9.0% of visits, DAPSA remission in 19.8%, cDAPSA remission in 23.4% and CPDAI remission in 30.2%. Of 258 patients, MDA criteria (≥5/7) were fulfilled in 46.5%. Of those in MDA, VLDA criteria were reached in 25.0%. Patients met the pain VAS target in 57.5 % of visits when they were in MDA, 43.3% when in LDA (MDA 5-6/7) and 44.8% when in CPDAI remission. Multivariate regression analysis revealed that pain VAS was the least likely target to be achieved. Patients with inflammatory-type back pain had significantly higher pain scores; furthermore, a significant relationship was seen between BASDAI and pain VAS.Based on our analysis, VLDA proved the most stringent target of disease remission in PsA compared to CPDAI, DAPSA and cDAPSA. The pain VAS target of ≤1.5 cm was the most difficult component to achieve. CPDAI ≤2 was found to be the least stringent remission target; however, measurements of axial involvement, which contributed to the elevated pain VAS score in patients not achieving VLDA, were only included as a domain in CPDAI.
Authors: Flora Farkas, Natsumi Ikumi, Musaab Elmamoun, Agnes Szentpetery, Oliver FitzGerald