E.YU. AKULINUSHKINA¹, L.V. IVANOVA¹, S.P. YAKUPOVA^{2, 3}

 ¹Republican Clinical Diagnostic Center, Izhevsk

²Kazan State Medical University, Kazan

³Republican Clinical Hospital, Kazan

Contact details:

Akulinushkina E.Yu. — therapist

Address: 87B Lenin St., 426000 Izhevsk, Russian Federation, tel.: +7-999-228-37-92, e-mail: katewenterly@gmail.com

 The purpose — to identify and analyze the minimal disease activity (MDA) domains in psoriatic arthritis (PsA) most difficult to achieve in clinical practice.

Material and methods. The research included 114 adult patients with PsA who were admitted to the Republican Clinical Diagnostic Center and assessed for compliance with the MDA criteria.

Results. The MDA was identified in 5 (4.4%) patients. The most common domains that prevented to achieve MDA were: patient’s assessment of disease activity (112 (98.2%) patients assessed disease activity as > 20 mm), pain by the visual analogue scale (106 (92.3%) patients noted pain as > 15 mm), and tender joints (2 or more tender joints were detected in 95 (83.3%) patients). The MAD domains less difficult to achieve were: swollen joints (2 or more swollen joints were detected in 75 (65.8%) patients), HAQ-DI questionnaire (HAQ-DI > 0.5 points were determined in 64 (56.1%)), psoriasis (PASI > 1% and BSA > 3% were detected in 62 (54.4%)), and enthesitis (LEI index > 1 point was determined in 20 (17.5%) patients).

Conclusions. The study showed that the MDA domains most difficult to achieve in patients with PsA were the «controlled by the patient» domains that depend on the patient’s opinion of their somatic status. Better controllability was observed for «objective» domains (psoriasis, swollen joints, enthesitis). The patient’s assessment of disease activity and perception of condition are influenced by many factors, including anxiety-depressive disorders, psychological and social difficulties, fatigue, tiredness, chronic pain, persistent impairment of functional capabilities, and irreversible structural conditions.

Key words: psoriatic arthritis, minimal disease activity, chronic pain.

REFERENCES

1. Kubanov A.A., Nasonov E.L., Bakulev A.L. et al. Klinicheskie rekomendatsii po vedeniyu bol’nykh psoriaticheskim artritom [Clinical guidelines for the management of patients with psoriatic arthritis], available at: https://cr.minzdrav.gov.ru/schema/562_3 (accessed on: 05.01.2025).
2. Coates L.C., Nash P., Kvien T.K. et al. Comparison of remission and low disease activity states with DAPSA, MDA and VLDA in a clinical trial setting in psoriatic arthritis patients: 2-year results from the FUTURE 2 study. Semin Arthritis Rheum, 2020, vol. 4, pp. 709–718.
3. Lubrano E., De Socio A., Perrotta F.M. Comparison of composite indices tailored for psoriatic arthritis treated with csDMARD and bDMARD: a cross-sectional analysis of a longitudinal cohort. J. Rheumatol, 2017, vol. 44, pp. 1159–1164.
4. de Vlam K., Steinfeld S., Toukap A.N. et al. The burden of psoriatic arthritis in the biologics era: data from the Belgian Epidemiological Psoriatic Arthritis Study. Rheumatology (Oxford), 2021, vol. 60 (12), pp. 677–685.
5. Coates L.C., Fransen J., Helliwel P.S. Defining disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann. Rheum. Dis, 2010, vol. 69, pp. 48–53.
6. Tucker L.J., Coates L.C., Helliwell P.S. Assessing disease activity in psoriatic arthritis: a literature review. Rheumatol. Ther, 2019, vol. 6, pp. 23–32.
7. Coates L.C., Helliwell P.S. Defining low disease activity states in psoriatic arthritis using novel composite disease instruments. J. Rheumatol, 2016, vol. 43, pp. 371–375.
8. Lubrano E., Scriffignano S., Perrotta F.M. The “climb” towards minimal disease activity in psoriatic arthritis. Rheumatol. Ther, 2021, vol. 8 (3), pp. 1443–1450.
9. Taylor W.J., Gladman D.D., Helliwell P.S. et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum, 2006, vol. 54 (8), pp. 2665–2673.
10. Tsarik G.N., Ivoylov V.M., Polyanskaya I.A. Informatika i meditsinskaya statistika [Informatics and medical statistics]. Moscow: GEOTAR-Media, 2017. 304 p.
11. Korotaeva T.V., Loginova E.Yu., Gubar’ E.E. et al. Achieving minimal disease activity in psoriatic arthritis depending on the time of administration of synthetic disease-modifying antirheumatic drugs, comparative analysis of the efficacy of oral and subcutaneous forms of methotrexate. Data from the All-Russian Registry of Patients with Psoriatic Arthritis. Sovremennaya revmatologiya, 2021, no. 15 (1), pp. 27–31 (in Russ.).
12. Marin J., Acosta Felquer M.L., Ferreyra Garrot L. et al. Patients with psoriatic arthritis fulfilling the minimal disease activity criteria do not have swollen and tender joints, but have active skin. J. Rheumatol, 2016, vol. 43, pp. 907–910.
13. Bakirci S., Solmaz D., Al Osaimi N. et al. What are the main barriers to achieve minimal disease activity in psoriatic arthritis in real life? Clin. Exp. Rheumatol, 2019, vol. 37 (5), pp. 808–812.
14. Lubrano E., Scriffignano S., Perrotta F.M. Residual disease activity and associated factors in psoriatic arthritis. J. Rheumatol, 2020, vol. 47, pp. 1490–1495.
15. Polishchuk E.Yu., Karateev A.E., Potapova A.S. et al. Need to evaluate the effectiveness of therapy? Ask the patient! Nauchno-prakticheskaya revmatologiya, 2023, no. 61 (3), pp. 361–368 (in Russ.).
16. Lubrano E., Scriffignano S., Azuaga A.B. et al. Assessment of the Patient Acceptable Symptom State (PASS) in psoriatic arthritis: association with disease activity and quality of life indices. RMD Open, 2020, p. 6:e001170.