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Patient-reported treatment success and failure in PsA

Apr 24, 2024
Learning objective: After reading this article, learners will be able to cite a new clinical development in psoriatic arthritis.

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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.


  • 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%.

Figure 1. The most commonly reported reasons for treatment failure*

*Adapted from Samuel, et al.1 Created with


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.

  1. Samuel C, Finney A, Grader-Beck T, et al. Characteristics associated with patient-reported treatment success in psoriatic arthritis. Rheumatol (Oxford). 2024. Online ahead of print. DOI: 1093/rheumatology/keae149

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