Mismatch between the impact of disease perceived by patients and the state of clinical remission assessed by physicians in psoriatic arthritis.

OBJECTIVES

Both the evaluation of disease activity and the assessment of the impact of the disease on patients' lives are subjects of intense research at present in psoriatic arthritis (PsA). We aimed to test the degree of concordance between the impact of the disease and the state of clinical remission defined by physicians in PsA.

METHODS

We conducted a post hoc analysis of a multicentre study that analysed 223 PsA patients treated with remission-inducing systemic drugs. Clinical remission was assessed by the Disease Activity in Psoriatic Arthritis (DAPSA) score and by the opinion of the evaluating physician (specific question yes/no). A patient-acceptable symptom state (PASS) corresponded to a Psoriatic Arthritis Impact of Disease (PsAID) value less than 4. The degree of agreement between remission and PASS was estimated by the Cohen's kappa (κ) index.

RESULTS

The degree of agreement between remission judged by physicians and the PASS status was low (κ: 0.16). There was a moderate agreement (κ: 0.46) between DAPSA remission and PASS, while there was almost a good concordance (κ: 0.58) between clinical DAPSA (without C-reactive protein) remission and PASS.

CONCLUSIONS

We found a clear disagreement between the impact of illness perceived by the patient with PsA and clinical remission judged by physicians. Therefore, clinical and treatment decision-making in PsA should be based more on composite indexes (DAPSA) than on the perceptions of treating physicians.