medwireNews: Some people with psoriatic arthritis (PsA) continue to experience a range of residual symptoms despite meeting stringent treatment targets, indicates a systematic review of real-world data.
“The findings demonstrate a need for further optimisation of care for patients with PsA,” write Laura Coates (University of Oxford, UK) and co-authors in Rheumatology and Therapy.
The team analyzed data from 27 observational studies including a total of 5138 patients with PsA, with the average age ranging from 41 to 59 years and disease duration from 4 to 15 years.
Among patients assessed by PsA-specific metrics across the studies, 14–100% achieved at least minimal disease activity (MDA) or low disease activity (LDA), while 12–43% achieved very low disease activity (VLDA) or remission.
However, despite meeting these treatment targets, residual symptoms in a range of domains “were frequently observed,” report Coates et al. For instance, 2–85% of patients who achieved at least MDA or LDA had a tender joint count (TJC) of at least one, with a mean TJC of 0.3–0.8.
The researchers say that residual musculoskeletal disease was “least evident” in groups “with disease control usually considered optimal,” namely those with VLDA according to the MDA criteria or remission according to DAPSA or clinical (c)DAPSA. A total of 0% and 0–8% of patients in these groups, respectively, had TJCs of at least one.
For residual skin disease, PASI scores of at least 1 point were seen in 25–39% of patients with DAPSA/cDAPSA remission and 19–34% of those with MDA.
The researchers also evaluated residual disease as measured by patient-reported outcomes, including patient global assessment VAS and HAQ-DI. They observed similar trends to those seen for musculoskeletal and skin outcomes, “with less residual disease in groups with more stringent disease control, and less residual disease in MDA and VLDA groups compared to DAPSA/cDAPSA LDA and [remission] groups, respectively.”
For example, 0–8% of patients with VLDA had HAQ-DI scores above 0.5, as did 4–15% of those with DAPSA/cDAPSA remission.
“Persistence of patient-reported symptoms, even among patients in VLDA or [remission], indicates that achieving stringent targets may still not result in satisfactory resolution of disease and acceptable disease impact from the patient’s perspective,” write Coates et al.
They conclude that their findings “highlight the need for further effective treatments and for continued refinement of strategies to reduce residual disease, both in patients aiming to achieve treatment targets and in those who have achieved them.”
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Rheumatol Ther 2022; doi:10.1007/s40744-022-00443-y