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      Impact of comorbidities on patient-reported outcomes in psoriatic arthritis: a single centre cohort study

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          Abstract

          Background

          Comorbidities are frequent in psoriatic arthritis (PsA) and may contribute to worse health-related outcomes. Patient-reported outcomes (PROs) are used to evaluate the burden of the assessed disease. The aim of this study is to evaluate the impact of comorbidities on selected PROs in PsA.

          Methods

          Adult patients, diagnosed with PsA, based on CASPAR criteria, were included in this cross-sectional, observational study. Collected data encompassed the comorbidities and PROs (Health Assessment Questionnaire [HAQ], Multi-Dimensional Health Assessment Questionnaire [MDHAQ], 36-Item Short Form Health Survey [SF-36]). Standard statistic methods were performed for data assessment.

          Results

          There were 267 participants included in the study (54.7% females). The most prevalent comorbidities were cardiovascular diseases (CVD) (29.2 %). Multimorbidity was observed in 50.2% cases and was associated with poorer results of SF-36 questionnaire, regarding bodily pain (34.7 [30.1, 39.3] vs. 47.5 [43.1, 52.0]; p<0.01), physical functioning (52.1 [47.3, 56.9] vs. 63.1 [58.9, 67.4]; p<0.01) and role physical (28.5 [21.2, 35.9] vs. 42.8 [35.2, 50.4]; p<0.01). CVD were associated with poorer MDHAQFn score (β=0.17, p<0.01), while mental disorders negatively influenced mental health (β= -0.35, p<0.01), vitality (β= -0.22, p<0.01), general health (β= -0.19, p<0.01), social functioning (β= -0.15, p=0.04) and role emotional (β= -0.30, p<0.01) dimensions of SF-36.

          Conclusions

          Multimorbidity exerts significant impact on physical aspects of quality of life (QoL) in PsA. CVD and mental disorders adversely influence functional capacity as well as mental and social dimensions of QoL, respectively. The impact of comorbidities should be taken into account by clinicians and researchers assessing PROs.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00296-024-05632-2.

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          Most cited references45

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          Classification criteria for psoriatic arthritis: development of new criteria from a large international study.

          To compare the accuracy of existing classification criteria for the diagnosis of psoriatic arthritis (PsA) and to construct new criteria from observed data. Data were collected prospectively from consecutive clinic attendees with PsA and other inflammatory arthropathies. Subjects were classified by each of 7 criteria. Sensitivity and specificity were compared using conditional logistic regression analysis. Latent class analysis was used to calculate criteria accuracy in order to confirm the validity of clinical diagnosis as the gold standard definition of "case"-ness. Classification and Regression Trees methodology and logistic regression were used to identify items for new criteria, which were then constructed using a receiver operating characteristic curve. Data were collected on 588 cases and 536 controls with rheumatoid arthritis (n = 384), ankylosing spondylitis (n = 72), undifferentiated arthritis (n = 38), connective tissue disorders (n = 14), and other diseases (n = 28). The specificity of each set of criteria was high. The sensitivity of the Vasey and Espinoza method (0.97) was similar to that of the method of McGonagle et al (0.98) and greater than that of the methods of Bennett (0.44), Moll and Wright (0.91), the European Spondylarthropathy Study Group (0.74), and Gladman et al (0.91). The CASPAR (ClASsification criteria for Psoriatic ARthritis) criteria consisted of established inflammatory articular disease with at least 3 points from the following features: current psoriasis (assigned a score of 2; all other features were assigned a score of 1), a history of psoriasis (unless current psoriasis was present), a family history of psoriasis (unless current psoriasis was present or there was a history of psoriasis), dactylitis, juxtaarticular new bone formation, rheumatoid factor negativity, and nail dystrophy. These criteria were more specific (0.987 versus 0.960) but less sensitive (0.914 versus 0.972) than those of Vasey and Espinoza. The CASPAR criteria are simple and highly specific but less sensitive than the Vasey and Espinoza criteria.
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            EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update

            Objective To update the European League Against Rheumatism (EULAR) recommendations for the pharmacological treatment of psoriatic arthritis (PsA). Methods According to the EULAR standardised operating procedures, a systematic literature review was followed by a consensus meeting to develop this update involving 28 international taskforce members in May 2019. Levels of evidence and strengths of recommendations were determined. Results The updated recommendations comprise 6 overarching principles and 12 recommendations. The overarching principles address the nature of PsA and diversity of both musculoskeletal and non-musculoskeletal manifestations; the need for collaborative management and shared decision-making is highlighted. The recommendations provide a treatment strategy for pharmacological therapies. Non-steroidal anti-inflammatory drugs and local glucocorticoid injections are proposed as initial therapy; for patients with arthritis and poor prognostic factors, such as polyarthritis or monoarthritis/oligoarthritis accompanied by factors such as dactylitis or joint damage, rapid initiation of conventional synthetic disease-modifying antirheumatic drugs is recommended. If the treatment target is not achieved with this strategy, a biological disease-modifying antirheumatic drugs (bDMARDs) targeting tumour necrosis factor (TNF), interleukin (IL)-17A or IL-12/23 should be initiated, taking into account skin involvement if relevant. If axial disease predominates, a TNF inhibitor or IL-17A inhibitor should be started as first-line disease-modifying antirheumatic drug. Use of Janus kinase inhibitors is addressed primarily after bDMARD failure. Phosphodiesterase-4 inhibition is proposed for patients in whom these other drugs are inappropriate, generally in the context of mild disease. Drug switches and tapering in sustained remission are addressed. Conclusion These recommendations provide stakeholders with an updated consensus on the pharmacological management of PsA, based on a combination of evidence and expert opinion.
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              Psoriatic Arthritis

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                Author and article information

                Contributors
                grzegorz.biedron@uj.edu.pl
                Journal
                Rheumatol Int
                Rheumatol Int
                Rheumatology International
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                0172-8172
                1437-160X
                25 June 2024
                25 June 2024
                2024
                : 44
                : 8
                : 1435-1443
                Affiliations
                [1 ]Department of Rheumatology and Immunology, Jagiellonian University Medical College, ( https://ror.org/03bqmcz70) Jakubowskiego 2, Kraków, Poland
                [2 ]GRID grid.412700.0, ISNI 0000 0001 1216 0093, Department of Rheumatology, Clinical Immunology and Internal Medicine, , University Hospital in Cracow, ; Kraków, Poland
                [3 ]Division of Rheumatology, Department of Internal Medicine, Sørlandet Hospital, ( https://ror.org/05yn9cj95) Kristiansand, Norway
                [4 ]Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, ( https://ror.org/05xg72x27) Trondheim, Norway
                Author information
                http://orcid.org/0000-0002-2643-9818
                http://orcid.org/0000-0001-7967-0880
                http://orcid.org/0000-0002-8748-7581
                http://orcid.org/0000-0002-2031-6657
                http://orcid.org/0000-0002-8698-6469
                http://orcid.org/0000-0001-5449-0680
                http://orcid.org/0000-0002-6371-8947
                http://orcid.org/0000-0002-9279-5191
                http://orcid.org/0000-0002-1749-9739
                Article
                5632
                10.1007/s00296-024-05632-2
                11222239
                38914774
                80249f38-4b54-482f-8382-f90aa46a04be
                © The Author(s) 2024

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                : 30 April 2024
                : 28 May 2024
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100005632, Narodowe Centrum Badań i Rozwoju;
                Award ID: 0026/2019–00
                Award Recipient :
                Categories
                Cohort Studies
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2024

                Rheumatology
                psoriatic arthritis,comorbidity,multimorbidity,patient reported outcome measure,quality of life

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