Predicting the achievement of a patient acceptable symptoms state for psoriatic arthritis

The aim of the study was to develop a method for predicting the achievement of a patient acceptable symptoms state (PASS) in patients with psoriatic arthritis (PsA).

Material and methods. The study included 52 patients (28 female and 24 male) diagnosed with PsA according to the CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria (2006). The mean age of the patients was 46±11.8 years, the median (Me) duration of psoriasis (PsO) was 132 [96; 183] months, PsA – 90 [72; 99] months, DAPSA (Disease Activity in Psoriatic Arthritis) – 18 [5.5; 37]. All patients at an early stage of PsA (duration up to 2 years) were monitored and treated according to the principles of the “treat-to-target” (T2T) strategy. By 24 months of observation, patients completed monitoring according to T2T and continued therapy in accordance with current clinical guidelines. After 7 years, all patients underwent a standard rheumatological examination, including assessment of PsA activity by DAPSA. Health-related quality of life (HRQoL) was evaluated using the PsAID-12 (Psoriatic Arthritis Impact of Disease) questionnaire. PsAID-12≤4 corresponded to achieving the PASS. To determine the predictors of achieving PASS, Spearman correlation analysis, univariate logistic regression, and subsequent multivariate stepwise logistic regression analysis were performed.

Results. By 7 years of observation, remission and low disease activity (LDA) by DAPSA were observed in the majority of patients – 31 (60%), swollen joint count (SJC) ≤3 in 38 (73%), C-reactive protein (CRP) ≤5 mg/L in 31 (60% and the number of patients achieving PASS was 38 (73%). Analysis showed that 32 out of 52 (61.5%) patients achieved remission within the first year of treatment and observation at the early stage of PsA.

Based on the results of the final analysis, a discriminant function was obtained, which included the following indicators associated with achieving PASS: age≤60 years (p=0.099), SJC≤3 (p=0.075), CRP≤5 mg/L (p=0.023), and achievement of DAPSA remission within the first year of treatment (p=0.324). A predictive expression for assessing the probability of achieving PASS was obtained: 1.824 × Age≤60 years (0 – no, 1 – yes) + 1.585 × SJC≤3 (0 – no, 1 – yes) + 2.062 × CRP ≤5 mg/L (0 – no, 1 – yes) + 0.783 × Achievement of DAPSA remission within the first year of treatment (0 – no, 1 – yes) – 2.775. According to the model, the probability of achieving PASS for each patient is calculated using the expression: . With calculated p<0.5, low probability of achieving PASS is determined, with values ≥0.5 – high probability. The prognostic model demonstrated high diagnostic accuracy: sensitivity 89.5%, specificity 64.3%, accuracy – 82.7%.

Conclusions. The developed method for predicting the achievement of a patient acceptable symptoms state for PsA patients, incorporating a set of indicators such as patient age, SJC, CRP level, and patient history data (achievement of remission within the first year of treatment), enables assessment of treatment prospects for PsA patients. Depending on the results obtained, the method allows for adjustment of the patient’s therapy.

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