Patient-reported treatment success and failure in PsA

Psoriatic arthritis (PsA) can be associated with fatigue, pain, and psychological problems, which can impact quality of life.¹ Achieving treatment success is a common goal between physicians and patients; however, due to the heterogeneity of PsA, achieving treatment success can be challenging.¹ Treatment success is often defined by physician measures, and less is known about patient-defined treatment success.¹

Here, we summarize a single-center, cross-sectional study by Samuel et al.¹ published in Oxford Rheumatology on patient-reported measures of treatment success in PsA.

Methods¹

• Patients who met the Classification for Psoriatic Arthritis criteria were recruited from the John Hopkins Psoriatic Arthritis Program between 2018–2022.
• Patients received standard of care treatment, with adjustment of therapy every 3-6 months based on treat-to-target goals or attainment of low disease activity.
• The primary outcome of this study was based on a single-item questionnaire: ‘Today, considering the level of control of your psoriatic arthritis and psoriasis, do you consider your treatment has been successful?’. The response options were ‘Yes’ or ‘No'.
• PsA disease activity, patient-related outcomes, and treatment target state were also measured.
• Descriptive and multivariate logistic regression analyses were conducted to identify clinical predictors of treatment success.

Patient population¹

• A total of 178 patients were included in the study

• • The mean age was 51.7 years, with a mean Classification for Psoriatic Arthritis score of 3.7.
  • 52.2% of patients were female and 86% were white.
  • The median duration of PsA was 4 years, and 33.7% of patients experienced high disease activity based on the Disease Activity Index for Psoriatic Arthritis.

• Overall, 105 patients had complete data available across all the variables, which was used in the logistic regression models.

Key findings¹

• Overall, 65% of patients reported treatment success, with the remainder reporting treatment failure.
• Patients could choose a maximum of 14 reasons for treatment failure. The most commonly reported reasons for treatment failure were pain and fatigue (Figure 1). 

• Patient characteristics of body mass index, gender, and race did not impact reported success.
• The following Patient Reported Outcomes Information System (PROMIS) measures were significantly associated with treatment success:

• • fatigue;
  • sleep disturbance;
  • ability to participate in social activities;
  • anxiety and pain interference; and
  • physical function.

• Multiple regression model analyses indicated that the following factors are associated with patient-reported treatment success:

• • 66-swollen/68-tender joint count
  • PROMIS Physical Function score
  • PROMIS Fatigue score
  • PROMIS Pain score
  • Tumor necrosis factor inhibitor therapy
  • Psoriasis extent

• In general, patients who reported treatment success had lower Psoriatic Arthritis Impact of Disease 12 Pain scores, total joint tenderness 68 and total joint swelling 66 scores.
• For patients with data available (n = 145), the percent agreement between clinical disease activity index for PsA treatment target and patient-reported treatment success was 75.2%.

*Adapted from Samuel, et al.¹ Created with BioRender.com.

 

Key learnings

Quality of life measures have a significant impact on patient-reported treatment success, with pain and fatigue being the top reasons for treatment failure. Healthcare professionals may be able to increase patient-reported treatment success by considering treatment with tumor necrosis factor-inhibitors and instigating strategies to improve inflammatory arthritis, psoriasis, pain, physical function, and fatigue. This study is limited by its cross-sectional nature, which prevents measuring changes over time. In addition, it is possible that some patients were on a first-line therapy and were less treatment-experienced than others, which could influence their perception of treatment success.