How does PsA Impact Your Patients? Just Ask

Gossec L, de Wit M, Kiltz U, et al., A patient-derived and patient-reported outcome measure for assessing psoriatic arthritis: elaboration and preliminary validation of the Psoriatic Arthritis Impact of Disease (PsAID) questionnaire, a 13-country EULAR initiative. Ann Rheum Dis. (2014) 73:1012-1019. doi: 10.1136/annrheumdis-2014-205207.

Coaccioli S, Bruno AA, Celi G, et al., Validation of an original questionnaire for patients with psoriatic arthritis: The Psoriatic Arthritis Impact Profile (PAIP). Clin Ter. (2014) 165:e100-108. doi: 10.7471/CT.2014.1691.

As with rheumatoid arthritis (RA), a key to better clinical management of psoriatic arthritis may be simply asking patients how the disease affects their lives. But while there is an RA Impact of Disease (RAID) assessment tool, there is no similar questionnaire for PsA patients.

The Patient Reported Outcome Measures (PROMs) used in PsA clinical trials are based on the RAID tool, so the European League Against Rheumatism (EULAR) has proposed developing PsA-specific PROMs assessments.

In response, rheumatologists in France and Italy have devised two PsA questionnaires designed to be used everyday practice and in clinical trials.

The French questionnaire is called the PsA Impact of Disease (PsAID) and the Italian version, the Psoriatic Arthritis Impact Questionnaire (PAIP).

Both questionnaires were found easy to use, researchers say, but they need further validation.

Here’s an overview:

Parsing the PsAID

The rheumatology service at the Hópital Pitié-Salpétrière in Paris developed two versions of the PsAID: a 12-item form (PsADI-12) for use in clinical practice and a nine-item version (PsAID-9) for randomized clinical trials.

The PsAID was developed with intensive patient participation to identify important areas of health (domains), prioritize them, and devise a numeric rating scale. Both versions give pain, fatigue, and skin problems the highest relative importance in calculating the impact of PsA. The domains and their relative importance ratings in clinical practice and RCTs are:

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They used a 13-country cross-sectional and longitudinal assessment to validate the questionnaire. The scores correlated well with patient global assessments, with greatest reliability in a small group of stable PsA patients, and an acceptable intraclass correlation coefficient and sensitivity to change.

PAIP

Researchers at the Perugia School of Medicine in Terny, Italy, devised the Psoriatic Arthritis Impact Questionnaire (PAIP), incorporating physical, social, psychosocial and economic factor ratings. They included:

1) Acceptance of disease

2) Anxiety or depression after diagnosis

3) Feelings about the future

4) Days missed from work or social activities

5) Effect on social and family life

6) Performance of daily activities including dressing, walking and going up and down stairs.

7) Daily time needed for taking care of PsA

8) Willingness to undergo treatment

9) Satisfaction with treatment and side effects

10) Yearly costs of treatment

They validated the PAIP by the comparing it with other accepted questionnaires, such as the HAQ and McGill Pain Questionnaire. PASI scores  were not affected by age or gender, but did vary according to duration of disease, its impact on social activities (mostly a function of severe skin lesions), and a frequent feeling of stigmatization.

Statistical comparisons between the PAIP and other questionnaires validated the tool for use in clinical evaluation and management. The authors say the PAIP is easy to use takes only 5 minutes to complete.