Leen Hashem, Clinical Analyst at Sidekick Health
Ogdie A. et al., Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry. Rheumatology and Therapy. 2022 Apr;9(2):735-751
The study aimed to improve our understanding of the burden of psoriatic arthritis (PsA) symptoms, from joint pain to nail pitting, and the impact of the disease on patients’ physical, social, and emotional functioning. The study also evaluated patients’ treatment preferences, including the mode and frequency of treatment administration.
Why it’s Important
Psoriatic arthritis is a chronic inflammatory disease that develops in up to 30% of patients with psoriasis. Psoriatic arthritis symptoms include joint pain, joint swelling, fatigue, and pruritis, among many others. Additionally, a large percentage of individuals with PsA also present with anxiety and depression, further contributing to a reduction in patient quality of life (QoL).
Despite recent advances in the treatment of PsA, however, less than 50% of patients in clinical trials reach pre-defined treatment targets.
This could be due to the heterogeneity of the disease and/or the impact of mental and emotional aspects of PsA on patient outcomes. Engaging patients to identify such unmet treatment-related needs may ultimately lead to better care.
Patients (N=332) were recruited from ArthritisPower, a rheumatology research registry, and were asked to complete a survey comprised of a series of questions surrounding their experiences of living with PsA.
A best-to-worst scaling method was used to rank the burden of 11 PsA symptoms, including skin pain and itching, and the importance of improvement on 9 PsA-related disease impacts, including sleep quality and the ability to do daily activities.
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- Joint pain (98%), fatigue (94%), and morning stiffness (94%) were the most common psoriatic arthritis symptoms experienced by patients in this study.
- However, the patients found joint pain to be the most bothersome symptom of PsA, followed by lower back or spine pain and tender or painful tendons and ligaments.
- Interestingly, fatigue was the second most bothersome symptom of PsA, after musculoskeletal pain (i.e., joint pain, lower back or spine pain, and tender or painful tendons and ligaments)
- The most reported disease impacts of PsA were related to the ability to perform physical activities (93%) and sleep quality (92%).
- The majority of patients (60%) also experienced impacts to their emotional well-being stemming from their PsA.
- 42% of patients had experienced all nine functional, social/emotional, and QoL impacts.
Patient Aspirations for Outcomes
- Patients ranked improving the ability to perform physical activities (exercising, walking, and climbing stairs) highest.
- 74% preferred a medicine that would provide significant or complete improvements in joint symptoms with mild to no improvements in skin symptoms, over a medicine that would provide significant or complete improvement in skin conditions with mild to no improvements in joint symptoms.
Patient Treatment Preferences
- Nearly half of patients (46%) felt that mode and frequency of treatment administration was an important factor when making treatment decisions.
- When asked to select their first choice for mode of administration, 38% of patients chose once-daily oral medications, followed by injection once a month (25%).
- 28% of patients had experience taking methotrexate. Nearly half of these (47%) stated they would strongly prefer a treatment that does not include methotrexate.
- Top reasons for dissatisfaction with methotrexate included dislike of short-term side effects (58%), lack of efficacy (53%), and fear of long-term side effects (44%)
There are several unmet needs for PsA patients, particularly those relating to the improvement of joint pain, fatigue, sleep quality and mental health.
Physicians are likely to benefit from early access to tools that help personalize therapies and treatment targets to patients – especially if the patient is dissatisfied with treatment outcomes. Importantly, though, patients could also use tools that help improve sleep, medication adherence and emotional wellbeing, which may be given with pharmacological therapies to enhance treatment outcomes.
The findings from this study can better inform development of new therapies and guide shared patient-provider treatment decision-making. By adopting more tailored approaches to patient care, physicians can ensure that patients achieve the best possible outcomes.
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About the author
Nessie Riley is a medical writer, veterinarian, and advocate for accessible healthcare for all.