Multidomain presentations linked to worse disease activity in psoriatic arthritis

In a real-world cohort of more than 2,000 U.S. patients with psoriatic arthritis, most had multidomain presentations, which were associated with worse disease activity, quality of life and work productivity, according to data published in The Journal of Rheumatology.

“PsA domain presentations are often heterogeneous, ranging from single to multiple disease domains,” Alexis Ogdie, MD, MCSE, of the University of Pennsylvania Perelman School of Medicine, and colleagues wrote.

“Because the frequency, type, and severity of the disease domains may impact treatment effectiveness and disease outcomes, careful consideration of the disease domain by the clinician may be critical for choosing the appropriate treatment,” they added. “There are limited real-world studies examining disease domain presentation among patients with PsA; our group has previously characterized patients with PsA affected in a single domain.”

To examine disease characteristics, quality of life (QoL) and work productivity among patients with PsA who demonstrate multidomain, compared with single-domain, presentations, Ogdie and colleagues analyzed data from the Corrona PsA/SpA Registry. In all, they included 2,617 patients with PsA enrolled from March 2013 to August 2018. They evaluated six disease domains, including enthesitis, dactylitis, peripheral arthritis, nail psoriasis, axial disease and skin disease.

Alexis Ogdie

Ogdie and colleagues classified patients as having multidomain — defined as two or more domains — or single-domain disease presentations, with biologic initiators characterized separately. They then used linear regression models to study the association of multidomain presentations with disease characteristics, QoL and work productivity, compared with single-domain presentations.

According to the researchers, 64.9% of the included participants demonstrated multidomain presentations and 23.6% had single-domain presentations, while 11.5% had no active disease features. In addition, among the 354 patients who started biologics, 81.6% had multidomain presentations and 12.7% had single-domain presentations, while 5.6% demonstrated no active disease.

The most common single-domain presentation was skin disease, with 12.7%, while the most common multidomain presentation was peripheral arthritis plus skin disease, with 11.7%. Participants with multidomain presentations were more likely to demonstrate fibromyalgia, depression, anxiety and prior biologic use, compared with single-domain patients. In addition, multidomain presentations were associated with significantly worse patient and physician global assessments of disease activity, pain and fatigue, as well as worse Health Assessment Questionnaire Disability Index and EQ-5D scores. They also had work productivity at enrollment.

“This study highlights the heterogeneity of PsA and demonstrates that the majority of patients with PsA in a U.S. real-world setting presented with multiple active disease domains,” Ogdie and colleagues wrote. “These multidomain presentations are associated with increased clinical burden, including worse disease activity, QoL and work productivity measures.”

“Future studies can build on these results to identify clusters of domains that may affect response to individual therapies,” they added. “As a first step, however, increased physician awareness of the heterogeneity of disease presentations among patients with PsA is important for optimizing disease management.”