Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Rheumatology (Oxford). 2021 Nov 3;60(11):5292-5299. doi: 10.1093/rheumatology/keab220.
In PsA, the treatment objective is remission or low disease activity (LDA), but patients' perception of remission is poorly studied. This analysis aimed to identify factors associated with patient-defined remission.
This analysis uses ReFlaP data, an international PsA study, with remission defined as 'At this time, is your psoriatic arthritis in remission, if this means: you feel your disease is as good as gone?'. Variables associated with, first, patient-defined remission and, second, LDA were identified using multivariable logistic regression and principal component analysis (PCA) to explore correlated variables.
Of 424 patients (50.2% male, mean age 52 years) with established disease, 94 (22.2%) reported themselves as being in remission and 191 (45.0%) as LDA alone. In multivariable analysis pain, psoriasis, impact of disease, physician opinion of symptoms from joint damage and Groll comorbidity index were independent predictors of remission. For LDA, results were similar. Using PCA, variance explained was 74% by five components for men and 80% by six components for women. The key component from PCA for remission was, for both sex, disease impact (Psoriatic Arthritis Impact of Disease, pain and HAQ) explaining 22.2-27.5% of variance. Other factors included musculoskeletal disease activity, chronicity/joint damage, psoriasis, enthesitis and CRP. For LDA, similar factors were identified but the variance explained was lower (64-68%).
Many factors impact on patients' opinion of remission, dominated by disease impact. Disease activity in multiple domains, chronicity/age, comorbidities and symptoms due to other conditions contribute to a robust model highlighting that patient-defined remission is multifaceted.
Clinicaltrials.gov, http://clinicaltrials.gov, NCT03119805.
在 PsA 中，治疗目标是缓解或低疾病活动度（LDA），但患者对缓解的认知研究较少。本分析旨在确定与患者定义的缓解相关的因素。
本分析使用 ReFlaP 数据，这是一项国际 PsA 研究，将缓解定义为“此时，您的银屑病关节炎是否处于缓解期，如果这意味着：您感觉您的疾病已经痊愈？”。使用多变量逻辑回归和主成分分析（PCA）来识别与患者定义的缓解和 LDA 相关的变量。
在 424 名（50.2%为男性，平均年龄 52 岁）已确诊疾病的患者中，94 名（22.2%）报告自己处于缓解期，191 名（45.0%）仅处于 LDA 期。在多变量分析中，疼痛、银屑病、疾病的影响、医生对关节损伤症状的看法和 Groll 合并症指数是缓解的独立预测因素。对于 LDA，结果类似。使用 PCA，男性有五个组成部分解释了 74%的方差，女性有六个组成部分解释了 80%的方差。对于男女患者，缓解的关键组成部分都是疾病影响（银屑病关节炎疾病影响、疼痛和 HAQ），解释了 22.2-27.5%的方差。其他因素包括肌肉骨骼疾病活动度、慢性/关节损伤、银屑病、肌腱炎和 CRP。对于 LDA，也确定了类似的因素，但解释的方差较低（64-68%）。
许多因素影响患者对缓解的看法，主要是疾病的影响。多个领域的疾病活动度、慢性/年龄、合并症以及其他疾病的症状都有助于建立一个稳健的模型，突出了患者定义的缓解是多方面的。
Clinicaltrials.gov，NCT03119805。
