Factors associated with achieving an acceptable health-related quality of life in the treatment of patients with psoriatic arthritis

Abstract

Objective: to analyze factors associated with the achievement of acceptable health-related quality of life (HRQoL) in patients with psoriatic arthritis (PsA) 7 years after the start of observation.Material and methods. The study included 53 patients (28 women, 25 men) with PsA who met the 2006 CASPAR criteria. The mean age of patients was 45.7±12.0 years, the median duration of PsA was 90 [72; 99] months, and the observation period was 81 [61; 91] months. The study included patients in early stage of PsA (duration up to 2 years), who were treated according to the “treat-to-target” strategy (T2T) for 24 months. Subsequently, all patients continued therapy according to the standards of medical care under the supervision of the treating physician. Over time, a standard rheumatological examination was performed. Activity of PsA was assessed by DAPSA, psoriasis by BSA, HRQoL by Psoriatic Arthritis Impact of Disease (PsAID-12); body mass index (BMI, kg/m2 ) and functional status by HAQ were also assessed. PsAID-12 ≤4 corresponded to achieving a Patient Acceptable State Status (PASS). The results were analyzed in two groups of patients: PsAID-12 ≤4 and PsAID-12 >4. The number of patients (%) who achieved minimal disease activity (MDA) after 1–2 years of active treatment and after 7 years was assessed. X-rays of the hands and feet (n=42) were performed using standard methods, changes were assessed using the Sharp/van der Heijde method modified for PsA (m-Sharp/van der Heijde).Results and discussion. After 7 years, 38 (71.7%) of 53 patients were found to have PASS. Patients who achieved PASS had significantly lower PsA and psoriasis activity, lower CRP levels, lower m-Sharp/van der Heijde scores, better functional status and HRQoL, and lower BMI at baseline. Factors associated with achieving PASS were identified: absence of nail psoriasis, BSA ≤3%, CRP ≤5 mg/l, number of swollen joints ≤3, number of painful joints ≤5, HAQ ≤0.5 at baseline and after 24 months, and achievement of MDA during the first 12 months of treatment.Conclusion. The majority of PsA patients treated at an early stage according to T2T principles had PASS, which is associated with low disease activity, fewer joint erosions, better functional status and achievement of MDA during the first 12 months of therapy. These factors should be considered when predicting disease progression.