Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Rheumatology (Oxford). 2021 Jul 1;60(7):3165-3175. doi: 10.1093/rheumatology/keaa766.
We aimed to investigate the disease activity and overall disease burden of (subgroups of) patients with PsA using the Psoriatic Arthritis Disease Activity Score (PASDAS) in an already tightly monitored cohort.
This is a cross-sectional study evaluating data from the first visit of 855 PsA patients after implementation of the PASDAS in our tightly monitored cohort [e.g. DAS 28 (DAS28) was provided as an anchor]. Differences in clinical outcomes between subgroups of patients using established cut-offs for disease activity status [i.e. very low (VLDA), low (LDA), moderate (MDA), and high disease activity (HDA)] were examined.
Based on the PASDAS, 53.1% of patients were in VLDA/LDA. 29.5% of patients had ≥1 swollen joint, 20.6% had ≥1 enthesitis index point and 3.0% had active dactylitis. Based on DAS28, 77.5% of the patients were in VLDA/LDA. Patients reaching both DAS28 VLDA/LDA status and PASDAS VLDA/LDA status [N = 445 (52.0%)] were compared with patients reaching only DAS28 VLDA/LDA status [N = 218 (25.5%)]. For these latter patients, significantly worse scores on separate parameters were found in measures used for PASDAS/DAS28 calculation (e.g. swollen and tender joint count and patient's visual analogue scale global disease activity) as well as other disease measures (e.g. function and inflammatory back pain). This result remained, even when the stricter VLDA cut-off was used for the DAS28.
PASDAS implementation uncovered relevant residual disease activity in a quarter of patients previously assessed as being in DAS28 VLDA/LDA, underscoring the potential value of PASDAS measurements in PsA clinical care.
我们旨在通过 PASDAS 评估已经接受严密监测的队列中（亚组）患者的疾病活动度和整体疾病负担。
这是一项横断面研究，评估了在我们严密监测的队列中实施 PASDAS 后 855 例 PsA 患者首次就诊的数据[例如，DAS28（DAS28）作为锚定物]。使用疾病活动状态的既定切点评估亚组患者之间的临床结局差异[即极低疾病活动度（VLDA）、低疾病活动度（LDA）、中度疾病活动度（MDA）和高疾病活动度（HDA）]。
根据 PASDAS，53.1%的患者处于 VLDA/LDA。29.5%的患者有≥1个肿胀关节，20.6%的患者有≥1个肌腱压痛指数点，3.0%的患者有活动性指（趾）炎。根据 DAS28，77.5%的患者处于 VLDA/LDA。达到 DAS28 VLDA/LDA 状态和 PASDAS VLDA/LDA 状态的患者[N=445（52.0%）]与仅达到 DAS28 VLDA/LDA 状态的患者[N=218（25.5%）]进行比较。对于这些后者患者，在用于 PASDAS/DAS28 计算的单独参数（例如肿胀和压痛关节计数以及患者的视觉模拟量表总体疾病活动度）以及其他疾病指标（例如功能和炎症性背痛）中发现了明显更差的评分。即使 DAS28 使用更严格的 VLDA 切点，结果仍然如此。
在先前评估为 DAS28 VLDA/LDA 的患者中，有四分之一的患者通过 PASDAS 发现了明显的残余疾病活动，这突显了 PASDAS 测量在 PsA 临床护理中的潜在价值。
