Moderate psoriatic arthritis: Burden of disease and unmet needs
What is moderate psoriatic arthritis?
Moderate psoriatic arthritis encompasses a variety of manifestations that contribute to disease burden.45,64—69 Patients with moderately active disease may have limited joint involvement (oligoarticular or low-range polyarticular disease)64—67, as well as any of the other key domains of psoriatic arthritis (see Figure 10)45. More than 50% of patients also have at least one comorbidity associated with psoriatic arthritis. 68 An additional characteristic of moderate psoriatic arthritis is the lack of poor prognostic factors that would indicate severe disease:70
- No highly active disease (e.g. erosive disease, highly active enthesitis and/or dactylitis, elevated levels of inflammation markers such as ESR and CRP attributable to psoriatic arthritis, and joint deformities that interfere with function)
- No rapidly progressive disease or long-term damage
In these patients, symptoms may be considered as not severe enough for biologics; patients with limited joint involvement are likely to have less erosive disease.69
Dr William Tillett and Professor Pascal Richette discuss the patient with moderate psoriatic arthritis and the burden of disease.
Moderate psoriatic arthritis is associated with a considerable disease burden
Patients with limited joint involvement report a significant burden of disease, comparable to polyarticular disease (see Figure 9).64,65,67,71
Despite being considered by their physicians to have reached an acceptable disease state, approximately 35% of patients have residual disease activity while being treated with conventional treatments.72 These patients do not have their treatment adjusted, despite alternatives being available.45,73
Rheumatologists need to consider the potential involvement of the different domains of psoriatic arthritis. GRAPPA recommendations indicate that the treatment goal of psoriatic arthritis should be the lowest possible disease activity across all domains of the disease.45 To achieve this treatment goal, patients should be promptly and regularly evaluated and have treatments adjusted accordingly.45
Fig. 9 Patient burden of disease is similar across PsA phenotypes
Fig. 10 Presence of core domains in psoriatic arthritis
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