Definition of Remission and Disease Activity Assessment in Psoriatic Arthritis: Evidence and Expert-Based Recommendations |
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Authors: | Raquel Almodóvar Juan D. Cañete Eugenio de Miguel José Antonio Pinto Rubén Queiro |
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Affiliation: | 1. Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Madrid, Spain;2. Department of Rheumatology, Hospital Clínic e IDIBAPS, Barcelona, Spain;3. Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain;4. Department of Rheumatology, Complexo Hospitalario Universitario de A Coruña, Spain;5. Department of Rheumatology, Hospital Universitario Central de Asturias, Spain |
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Abstract: | ObjectiveWe aimed to reach a consensus on the best instruments to monitor disease activity in patients with psoriatic arthritis (PsA) and to develop a consensus definition of remission.MethodsA modified Delphi approach was used. A scientific committee provided statements addressing the definition of remission and the monitoring of PsA in clinical practice. The questionnaire was evaluated in 2 rounds by rheumatologists with experience in managing PsA patients.ResultsA panel of 77 rheumatologists reached agreement on 62 out of the 86 proposed items (72.0%). The most recommended index for monitoring disease activity was DAPSA (cut-off values: ≤4 for remission and >4–14 for low disease activity ([LDA]), MDA (at least 5/7 criteria). In cases with axial involvement, ASDAS was the preferred index (cut-off values: <1.3 for remission and <2.1 for LDA). BASDAI (cut-off values: ≤2 for remission and ≤4 for LDA) may be used as an alternative. PsAID was the preferred tool to assess disease impact.ConclusionWe propose a definition of remission in PsA as the absence of disease activity evaluated by DAPSA or MDA (ASDAS and/or BASDAI in patients with axial involvement), which would imply absence of signs or symptoms of inflammation, physical well-being, lack of disease impact, and absence of inflammation as measured by biological markers. |
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Keywords: | Arthritis Psoriatic Remission Inflammation Drug monitoring Delphi technique Outcome and process assessment (health care) Artritis psoriásica Remisión Inflamación Monitoreo de drogas Técnica Delphi Evaluación de procesos y resultados (atención de salud). |
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