The majority of patients living with PsA reported experiencing “unacceptable” disease activity, causing potentially serious psychosocial harm, according to survey results collected by researchers with the National Psoriasis Foundation.

“Many efficacious therapies for PsA exist. However, the chronic, heterogeneous nature of the disease and involvement of comorbidities can frustrate long-term disease control,” wrote Melissa P. Zundell, MD, and colleagues in the journal JID Innovations. “As a result, many patients do not achieve or maintain remission. Therefore, it is important to understand the impact that disease activity and symptom control state have on patient outcomes.”

Previous research has indicated that up to 68% of patients with the condition live with acceptable symptom burdens, and that these patients have better outcomes than those who have “unacceptable” disease activity or symptoms. However, many patients do not have access to rheumatology care, meaning that as many as 33% of patients with the disease do not seek care from a rheumatologist, the authors added.

“Real world research on the prevalence of unacceptable symptom state and its effect on mental health and social function may inform treatment optimization,” Dr. Zundell and colleagues said.

Measuring Patient Experiences

The researchers surveyed 801 patients who had all been active members of the National Psoriasis Foundation for at least two years at the time of the study. Patients were at least 18 years old and had completed the Psoriatic Arthritis Index of Disease (PsAID-9) questionnaire.

Making use of established cut off points, researchers classified the patients as having “acceptable level of disease impact” if they had a PsAID-9 score of up to 4; those whose scores were greater than 4 were considered to have an “unacceptable level of disease impact.”

Researchers also collected data on self-reported body surface area (BSA) involvement as measured by the Patient Report of Extent of Psoriasis Involvement index, assessed depression in patients using the Patient Health Questionnaire-2 (PhQ2), and examined patients’ social participation using the Patient-Reported Outcomes Measurement Information System Ability to Participate in Social Roles and Activities tool.

Most patients (n=727, 90.8%) reported that they were diagnosed with both psoriasis and PsA. Nearly two-thirds (62.7%) were women, most were White or Caucasian (87.9%), and 62.9% were older than 50 years of age. Just over half (54.9%) had BSA involvement of less than 3%.

More than half of respondents (59.6%) had PsAID-9 scores greater than 4, indicating that they had unacceptable levels of disease activity.

Approximately one-third (32.1%) had possible depression, a figure the investigators called “considerably higher” than the prevalence of depression in the general population.

When asked about their ability to fulfill their social roles, 31.5% of patients reported they were “mildly limited,” and 42.7% had a “normal” ability to participate in social activities. More than three-quarters of respondents (82.5%) had at least mild social impairment.

After adjusting for psoriasis severity, age, and sex, the researchers found that patients who likely had depression and those who had limited abilities to participate in social activities were more likely to experience unacceptable disease activity compared with those who were not depressed and could participate (OR, 0.014; P< 0.001 for depression; OR, 0.05; P<0.001 for limited social activity).

Real-World PsA Management

“The study reveals that approximately 60% of patients with PsA in the US continue to experience significant symptoms, leading to notable declines in social activity and an increased prevalence of depression,” the researchers wrote.

The authors acknowledged that the study was subject to selection bias because it focused on patients who were already engaged with an advocacy organization. Previous research has indicated that members of the National Psoriasis Foundation tended to be more affluent, have more severe disease, and be more informed about treatment options compared with those who were not affiliated with an organization. The study population was also more proportionally White and female than the general population.

The researchers pointed out that many of the patients who responded to the survey were receiving specialty care for their disease and still had uncontrolled symptoms. Nevertheless, the investigators said their results support conventional wisdom that monitored treatment with the help of a dermatologist or rheumatologist improves outcomes for people living with PsA.

“Both PsA and depression necessitate a more proactive and comprehensive screening and management approach across the various specialties managing psoriatic care,” Dr. Zundell and colleagues said.

They suggested that tools like the PSAID-9 and PHQ-2 might help clinicians evaluate patients for psychosocial distress in real-world settings.

“While previous suggestions for dermatologists to be more proactive in screening for PsA hold merit, it is crucial to shift the focus from diagnosis to control,” Dr. Zundell and colleagues wrote. “The establishment of streamlined protocols to facilitate their integration in-to clinical practice would offer considerable benefit to patients.”