A. Ogdie, MD, MCSE, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania;
P. Hur, PharmD, MBA, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey.
J Rheumatol. 2021 May;48(5):698-706. doi: 10.3899/jrheum.200371. Epub 2020 Oct 1.
To compare disease characteristics, quality of life (QOL), and work productivity of patients with psoriatic arthritis (PsA) who had multidomain vs single-domain presentations.
Adults with PsA enrolled in the Corrona PsA/Spondyloarthritis Registry (March 2013-August 2018) were included. Six PsA disease domains were evaluated: enthesitis, dactylitis, peripheral arthritis (PA), nail psoriasis, axial disease, and skin disease. Patients were classified as having multidomain (≥ 2 domains) or single-domain disease presentations; biologic initiators were characterized separately. Linear regression models evaluated the association of multidomain presentations with disease characteristics, QOL, and work productivity vs single-domain presentations.
Of 2617 patients with PsA, 1698 (64.9%) had multidomain presentations, 617 (23.6%) had single-domain presentations, and 302 (11.5%) had no active disease features. Of 354 biologic initiators, 289 (81.6%) had multidomain presentations, 45 (12.7%) had single-domain presentations, and 20 (5.6%) had no active disease features. Overall, the most common single-domain and multidomain presentations, respectively, were skin disease (12.7%) and PA + skin disease (11.7%). Multidomain presenters were more likely to have fibromyalgia, depression, anxiety, and prior biologic use than single-domain presenters. Multidomain presentations were associated with significantly worse patient and physician global assessments of disease activity, pain, and fatigue; Health Assessment Questionnaire-Disability Index and EuroQol 5-dimension scores; and work productivity at enrollment.
In this US real-world cohort, most patients had multidomain disease presentations, which was associated with worse disease activity, QOL, and work productivity measures. This study highlights the heterogeneity of PsA and the importance of assessing all PsA domains for optimizing disease management.
比较多关节型和单关节型银屑病关节炎（PsA）患者的疾病特征、生活质量（QOL）和工作生产力。
纳入 2013 年 3 月至 2018 年 8 月期间参加 Corrona PsA/Spondyloarthritis 登记研究的成年 PsA 患者。评估了 6 个 PsA 疾病领域：附着点炎、指（趾）炎、周围关节炎（PA）、甲银屑病、中轴疾病和皮肤疾病。患者分为多关节型（≥2 个关节）或单关节型疾病表现；分别描述生物制剂的起始情况。线性回归模型评估了多关节表现与疾病特征、QOL 和工作生产力与单关节表现的相关性。
在 2617 例 PsA 患者中，1698 例（64.9%）有多关节表现，617 例（23.6%）有单关节表现，302 例（11.5%）无活动期疾病特征。在 354 例生物制剂起始者中，289 例（81.6%）有多关节表现，45 例（12.7%）有单关节表现，20 例（5.6%）无活动期疾病特征。总体而言，最常见的单关节和多关节表现分别为皮肤疾病（12.7%）和 PA+皮肤疾病（11.7%）。多关节表现者更有可能出现纤维肌痛、抑郁、焦虑和既往生物制剂使用。与单关节表现者相比，多关节表现者的疾病活动度、疼痛和疲劳的患者和医生总体评估、健康评估问卷残疾指数和欧洲五维健康量表评分以及入组时的工作生产力均显著更差。
在这项美国真实世界队列研究中，大多数患者有多关节疾病表现，这与疾病活动度、QOL 和工作生产力指标更差有关。本研究强调了 PsA 的异质性和评估所有 PsA 关节以优化疾病管理的重要性。
