Association Between Patient Perception of Disease Status and Different Components of the Minimal Disease Activity Criteria in Psoriatic Arthritis

Objective. The aim of this study was to evaluate whether meeting minimal disease activity (MDA) as measured by the MDA criteria was perceived as good disease control by patients with psoriatic arthritis (PsA) regardless of which MDA components were not met. Methods. We analyzed data from the Remission/Flare in PsA (ReFlaP) study (ClinicalTrials.gov: NCT03119805), a cross-sectional international study of adult patients with PsA. Patients self-reported if they felt their PsA was in remission (REM), low disease activity (LDA), or neither. The relationship between patient-reported status and the MDA components met was analyzed using point-biserial correlation, chi-square test, odds ratios, and specificity. Results. Of the study participants who met MDA, 88.4% reported good disease status (REM/LDA). Pain was the most commonly unmet component. A moderate to strong correlation was found between meeting more MDA components and patient-reported good status irrespective of component unmet. On individual component testing, MDA state and patient-reported REM/LDA were significantly associated irrespective of unmet component, with the exception of entheses. Specificity of the MDA score irrespective of the unmet component was > 90%. The odds of MDA patients reporting poor disease status were significant only for when pain visual analog score ( VAS) < 1 was the unmet component. This significance was not supported by the sensitivity analysis. Conclusion. This study suggests strong agreement between MDA status and patient-reported good status irrespective of unmet component. Pain < 1 or 2 on a 0-10 VAS was the hardest component to meet. The high specificity regardless of the unmet MDA component suggests patients who feel their disease is active are minimally misclassified by the score.