National survey of patients with psoriatic arthritis in Spain: disease activity, pharmacological therapy and impact on quality of life

Objective

To evaluate disease activity, management with pharmacological therapy and the impact on functional capacity and quality of life of psoriatic arthritis in Spain.

Methods

Cross-sectional, multicenter, national survey. The following data were collected: age, sex, type of psoriasis, swollen and tender joint counts (SJ 44/TJ 46), ESR (mm/1hora), CRP (mg/dL), DAS28, Psoriasis Global Assessment (PGA), Physician Global Assessment (PhyGA), Patient Global Assessment (PatGA), pharmacological therapy taken (AINEs, glucocorticoids, DAMARDs, and anti-TNFalfa therapy), Visual Analogue Scale (VAS) of pain, Disease impact as measured by VAS in the personal, occupational and social spheres, Health Assessment Questionnaire (HAQ) and Dermatology Life Quality Index (DLQI).

Results

214 patients with psoriatic arthritis fulfilling CASPAR criteria from 54 Spanish rheumatology outpatient clinics were included. Fifty-six per cent were male and the age was (mean (95%CI)) 52 years (50.1-53.8). Patient had the following clinical activity TJC: 3.2 (2.6-3.7); SJC: 2.4 (2-2.9); ESR: 20.6 (18.4-22.8) mm/1 h; CRP: 5.3 (3.7-6.8) mg/dL; DAS28: 3.10 (2.9-3.3); PhyGA: 24.7 (21.4-27.9); PatGA: 29.2 (25.2-33.2); VAS pain: 29.7 (25.5-38.8). Twenty four percent of patients had a moderate-severe extent of PsA as measured by PGA.

Of 173 patients from whom DAS28 was available, 38% were en remission (DAS28<2.6); 23% had low activity (DAS28>2.6<3.2) and 39% had moderate or high activity (DAS28>3.2). 98.6% of patients were taken drugs for treatment of psoriatic arthritis: 21% oral glucocorticoids (<5 mg of prednisolone), 86.2% DMARDs (96% methotrexate and/or leflunomide) and 26.2% anti-TNFalfa therapies.

Disease impact measured by VAS in the personal sphere was higher in females than in males (31.2 (25-37.4) vs 22.1 (16.7-27.5); p<0.03). The global HAQ was 0.61 (0.52-0.7), being significantly higher en females (0.84 (0.71-0.97) vs 0.4 (0.31-0.54);p<000001). Global DLQ was 3.5 (2.8-4.2), with youngest patients (18-29 years) reporting greater involvement (18% indicated severe o very severe effects, with scores between 11 and 30)).

Conclusions

This observational national survey on psoriatic arthritis is the first study trying to reflect the treatment and state of patients with psoriatic arthritis in Spain. Globally it suggest that although most patients are treated with DMARDs and one quarter with anti-TNFalfa blockers, around 40% exhibit moderate-high joint disease activity and around 25% moderate-high skin involvement. Furthermore, although the impact of the disease on functional capacity and psoriasis-related quality of life is globally mild-moderate, the group constituted by females and people of <30 years suffers a greater impact, suggesting the need of intensify the treatment of their joint and skin involvement.