Overlap Between Remission and Low Disease Activity Targets in Psoriatic Arthritis

Significant overlap exists between different remission and low disease activity targets in the treatment of psoriatic arthritis, according to a real-life study published in the Annals of the Rheumatic Diseases.¹ Guidelines for the treatment of psoriatic arthritis recommend that the target be remission or low disease activity^2,3; however, it is not clear what the target to measure the disease state should be.

Using an existing data set from a cross-sectional study of 250 patients with psoriatic arthritis, researchers evaluated various targets for remission and low disease activity.¹ They found that very low disease activity was achieved by the smallest proportion of patients, which suggests it may be the most stringent target for remission of inactive disease, although it could be difficult to attain. 

The modified minimal disease activity measures were the most stringent targets for low disease activity in patients achieving the target in terms of residual disease on joints, psoriasis, and enthesitis. The addition of C-reactive protein, however, did not demonstrate an added value in both remission and low disease activity measures. In the Disease Activity Index for Psoriatic Arthritis measures, the exclusion of a domain for psoriasis caused an inattention to skin disease and a negative effect on quality of life in some patients.

Although the different remission and low disease activity targets in the treatment of psoriatic arthritis have significant overlap between measures, these measures differ in terms of allowance of residual disease.¹ The authors commented that, “It remains unknown whether meeting a strict target such as [very low disease activity] is superior in reducing impact on patient outcomes such as [quality of life], radiographic progression and functioning, in comparison with less stringent targets. Ideally a trial comparing remission and low disease activity, incorporating efficacy, safety, cost-benefit and patient opinion is needed.”

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References

1. van Mens LJJ, van de Sande MGH, van Kuijk AWR, Baeten D, Coates LC. Ideal target for psoriatic arthritis? Comparison of remission and low disease activity states in a real-life cohort [published online October 28, 2017]. Ann Rheum Dis. doi:10.1136/annrheumdis-2017-211998
2. Coates LC, Kavanaugh A, Mease PJ, et al. Group for research and assessment of psoriasis and psoriatic arthritis 2015 treatment recommendations for psoriatic arthritis. Arthritis Rheumatol. 2016;68(5):1060-1071.
3. Gossec L, Smolen JS, Ramiro S, et al. European League Against Rheumatism (EULAR) recommendations for the management of psoriatic arthritis with pharmacological therapies: 2015 update. Ann Rheum Dis. 2016;75(3):499-510.