Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: An analysis of 410 patients from 14 countries

Clémence Gorlier, Ana-Maria Orbai, Déborah Puyraimond-Zemmour, Laura C. Coates, Uta Kiltz, Ying Ying Leung, Penelope Palominos, Juan D. Cañete, Rossana Scrivo, Andra Balanescu, Emmanuelle Dernis, Sandra Tälli, Adeline Ruyssen-Witrand, Martin Soubrier, Sibel Zehra Aydin, Lihi Eder, Inna Gaydukova, Ennio Lubrano, Umut Kalyoncu, Pascal RichetteM. Elaine Husni, Maarten De Wit, Josef S. Smolen, Laure Gossec

Research output: Contribution to journalArticle

Abstract

Background: The objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients' and physicians' perspectives. Methods: In ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA <14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally. Results: Of 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12-0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions. Conclusion: In this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.

Original languageEnglish (US)
JournalAnnals of the Rheumatic Diseases
DOIs
StateAccepted/In press - Jan 1 2018

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Psoriatic Arthritis
Physicians

Keywords

  • disease activity
  • patient perspective
  • psoriatic arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis : An analysis of 410 patients from 14 countries. / Gorlier, Clémence; Orbai, Ana-Maria; Puyraimond-Zemmour, Déborah; Coates, Laura C.; Kiltz, Uta; Leung, Ying Ying; Palominos, Penelope; Cañete, Juan D.; Scrivo, Rossana; Balanescu, Andra; Dernis, Emmanuelle; Tälli, Sandra; Ruyssen-Witrand, Adeline; Soubrier, Martin; Aydin, Sibel Zehra; Eder, Lihi; Gaydukova, Inna; Lubrano, Ennio; Kalyoncu, Umut; Richette, Pascal; Husni, M. Elaine; De Wit, Maarten; Smolen, Josef S.; Gossec, Laure.

In: Annals of the Rheumatic Diseases, 01.01.2018.

Research output: Contribution to journalArticle

Gorlier, C, Orbai, A-M, Puyraimond-Zemmour, D, Coates, LC, Kiltz, U, Leung, YY, Palominos, P, Cañete, JD, Scrivo, R, Balanescu, A, Dernis, E, Tälli, S, Ruyssen-Witrand, A, Soubrier, M, Aydin, SZ, Eder, L, Gaydukova, I, Lubrano, E, Kalyoncu, U, Richette, P, Husni, ME, De Wit, M, Smolen, JS & Gossec, L 2018, 'Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis: An analysis of 410 patients from 14 countries', Annals of the Rheumatic Diseases. https://doi.org/10.1136/annrheumdis-2018-214140
Gorlier, Clémence ; Orbai, Ana-Maria ; Puyraimond-Zemmour, Déborah ; Coates, Laura C. ; Kiltz, Uta ; Leung, Ying Ying ; Palominos, Penelope ; Cañete, Juan D. ; Scrivo, Rossana ; Balanescu, Andra ; Dernis, Emmanuelle ; Tälli, Sandra ; Ruyssen-Witrand, Adeline ; Soubrier, Martin ; Aydin, Sibel Zehra ; Eder, Lihi ; Gaydukova, Inna ; Lubrano, Ennio ; Kalyoncu, Umut ; Richette, Pascal ; Husni, M. Elaine ; De Wit, Maarten ; Smolen, Josef S. ; Gossec, Laure. / Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis : An analysis of 410 patients from 14 countries. In: Annals of the Rheumatic Diseases. 2018.
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abstract = "Background: The objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients' and physicians' perspectives. Methods: In ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA <14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally. Results: Of 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7{\%} were male, disease duration was 11.2 (8.2) years, 56.8{\%} were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4{\%} (VLDA) to 36.1{\%} (physician-perceived remission), and for LDA from 25.4{\%} (MDA) to 43.9{\%} (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4{\%}). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12-0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1{\%} and 51.5{\%}, respectively, and a specificity of 76.8{\%} and 88.0{\%}, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6{\%}) but performed poorly against other definitions. Conclusion: In this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.",
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TY - JOUR

T1 - Comparing patient-perceived and physician-perceived remission and low disease activity in psoriatic arthritis

T2 - An analysis of 410 patients from 14 countries

AU - Gorlier, Clémence

AU - Orbai, Ana-Maria

AU - Puyraimond-Zemmour, Déborah

AU - Coates, Laura C.

AU - Kiltz, Uta

AU - Leung, Ying Ying

AU - Palominos, Penelope

AU - Cañete, Juan D.

AU - Scrivo, Rossana

AU - Balanescu, Andra

AU - Dernis, Emmanuelle

AU - Tälli, Sandra

AU - Ruyssen-Witrand, Adeline

AU - Soubrier, Martin

AU - Aydin, Sibel Zehra

AU - Eder, Lihi

AU - Gaydukova, Inna

AU - Lubrano, Ennio

AU - Kalyoncu, Umut

AU - Richette, Pascal

AU - Husni, M. Elaine

AU - De Wit, Maarten

AU - Smolen, Josef S.

AU - Gossec, Laure

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: The objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients' and physicians' perspectives. Methods: In ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA <14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally. Results: Of 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12-0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions. Conclusion: In this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.

AB - Background: The objective was to compare different definitions of remission and low disease activity (LDA) in patients with psoriatic arthritis (PsA), based on both patients' and physicians' perspectives. Methods: In ReFlap (Remission/Flare in PsA; NCT03119805), adults with physician-confirmed PsA and >2 years of disease duration in 14 countries were included. Remission was defined as very low disease activity (VLDA), Disease Activity index for PSoriatic Arthritis (DAPSA) ≤4, and physician-perceived and patient-perceived remission (specific question yes/no), and LDA as minimal disease activity (MDA), DAPSA <14, and physician-perceived and patient-perceived LDA. Frequencies of these definitions, their agreement (prevalence-adjusted kappa), and sensitivity and specificity versus patient-defined status were assessed cross-sectionally. Results: Of 410 patients, the mean age (SD) was 53.9 (12.5) years, 50.7% were male, disease duration was 11.2 (8.2) years, 56.8% were on biologics, and remission/LDA was frequently attained: respectively, for remission from 12.4% (VLDA) to 36.1% (physician-perceived remission), and for LDA from 25.4% (MDA) to 43.9% (patient-perceived LDA). Thus, patient-perceived remission/LDA was frequent (65.4%). Agreement between patient-perceived remission/LDA and composite scores was moderate to good (kappa range, 0.12-0.65). When patient-perceived remission or LDA status is used as reference, DAPSA-defined remission/LDA and VLDA/MDA had a sensitivity of 73.1% and 51.5%, respectively, and a specificity of 76.8% and 88.0%, respectively. Physician-perceived remission/LDA using a single question was frequent (67.6%) but performed poorly against other definitions. Conclusion: In this unselected population, remission/LDA was frequently attained. VLDA/MDA was a more stringent definition than DAPSA-based remission/LDA. DAPSA-based remission/LDA performed better than VLDA/MDA to detect patient-defined remission or remission/LDA. Further studies of long-term outcomes are needed.

KW - disease activity

KW - patient perspective

KW - psoriatic arthritis

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U2 - 10.1136/annrheumdis-2018-214140

DO - 10.1136/annrheumdis-2018-214140

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