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New findings show that patient-reported outcome measures were strongly associated with several psoriatic arthritis disease activity indexes.

Patient-reported outcome measures (PROMs) are strongly linked with the Disease Activity Index for Psoriatic Arthritis (DAPSA) score for patients with psoriatic arthritis (PsA), researchers in Italy report. By paying attention to PROMs, clinicians can better understand their patients’ experiences, tailor more effective treatment plans, and monitor treatment responses more accurately.

“The key message is that it’s always important to listen to our patients. The authors looked at several PROMs, and they found that all had something to say about the impact of psoriatic arthritis on the patient,” says Eric M. Ruderman, MD, who was not involved in the study. “Patients’ perceptions of their disease, particularly the impact of their disease, is as important, if not more important, than the physician’s assessment.”

PsA, a multidimensional, variable chronic arthritis linked with psoriasis, can worsen QOL due to its wide-ranging effects on fatigue, pain, emotions, and ability to function in daily life. PROMs provide a useful tool for capturing patients’ perspectives on the disease’s effects. Nurses may educate patients on reporting their outcomes.

To better understand the utility of PROMs in clinical care, senior study author Salvatore Corrao, MD, and colleagues at the National Relevance and High Specialization Hospital Trust ARNAS Civico in Palermo conducted a cross-sectional study. The study included 158 consecutive adult outpatients treated at their institution’s PsA clinic from March 2018 to October 2020. Study participants were mostly female and had a median age of approximately 55 years. They had psoriatic arthritis for a median of 10.6 years. The median Disease Activity Index for Psoriatic Arthritis (DAPSA) score, which researchers used to assess joint manifestations, was 19.02.

Analyzing the data with linear regression, the researchers found strong relationships between the DAPSA score and various PROMs:

• Psoriatic Arthritis Impact of Disease (PsAID), to assess the impact of the disease on patients’ QOL (adjR² 26%, P<0.001)
• Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT-F), to assess fatigue (adjR² 4%, P<0.001)
• Health Assessment Questionnaire (HAQ), to assess functional disability (adjR² 7%, P<0.001)
• Patient Health Questionnaire-9 (PHQ-9), to assess depression (adjR² 15%, P<0.001)

The study authors wrote that their findings “provide useful information for understanding that some patient-reported outcome measures are as important as disease activity indexes” in assessing patients with psoriatic arthritis.

Understanding Your Patients’ Perspectives

“When we listen to what our patients tell us, we ultimately provide more impactful care,” Dr. Ruderman advises. “When we don’t consider the patient’s assessment, we do so at our own peril.”

Dr. Ruderman added that the study results did not surprise him because many studies have shown a disconnect between patients’ and physicians’ assessments.

“This is increasingly being discussed as a component of shared decision-making, but it’s just good medical care. Physicians tend to focus on objective signs of disease activity. Data that show the importance of patients’ subjective experiences can be an important tool to encourage physicians to look at disease activity more globally,” Dr. Ruderman said.

While data accuracy is the strength of this study, the single site is a limitation that can be overcome in a multicenter trial, according to the authors. Dr. Ruderman says that the cross-sectional study design is a limitation and adds, “It would be even more helpful to have information on the consequences of these patient-reported outcomes over time and whether any improvements are indicative of overall changes in disease impact.”

“Don’t be daunted by the specific PROMs they measured in this study. These are just tools. You could consider integrating these or other similar measures into your clinical practice,” he advises. “If that strikes you as too complicated, be sure to at least ask your patients about these issues because that will allow you to provide better care.”