Joint, Musculoskeletal Pain Ranked Most Vexing Symptom in Patients With PsA

Patients with psoriatic arthritis (PsA) reported musculoskeletal pain symptoms as the most bothersome and focused on improving functional impacts of the disease, according to a study published in Springer.¹ Investigators believe these findings can help inform the development of new therapies and guide treatment decisions.

“To adequately address the unique challenges of PsA, incorporating the patient perspective when developing new therapeutics is critical,” investigators stated. “Incorporating patient perspectives will not only help better tailor therapies in this heterogeneous population but also identify treatment targets that are relevant to the individual patients. Patient preferences are currently recommended for inclusion in clinical trials across major international PsA organizations.”

Patients with rheumatic disease registered in the US-based Global Healthy Living Foundation’s ArthritisPower registry were able to participant in a web-based, cross-sectional survey. Symptoms and impacts were determined using the Outcome Measures in Rheumatology (OMERACT). A best-worse scaling (BWS) was used to determine the burden of 11 PsA-related symptoms, as well as the importance of improvement in 9 PsA-related disease impacts. Symptom descriptions were added, and the “physical functioning” label, psoriasis symptoms, and diagnosis questions were expanded based on feedback. Data was evaluated using a random-parameters logit model.

Demographics, frequency and mode of therapy, and methotrexate-related preferences were assessed.

A total of 332 patients (94% White, 80% female) were included in the survey, with most reporting previous bDMARD therapy (n = 258). The mean age was 54 years (SD 11.4).

Results indicated that joint pain (98%) and other musculoskeletal pain, morning stiffness (94%) and fatigue (94%), were the most common symptoms ever experienced among this patient population, with 89% reporting joint pain, 85% reporting morning stiffness, and 84% reporting fatigue within the past week. Roughly a third (37%) experienced all 11 symptoms throughout the course of their disease. The most burdensome symptoms were joint pain, lower back or spine pain, fatigue, and tender or painful tendons and ligaments.

Improvements in physical activity (93%), sleep quality (92%), were the most reported disease impacts of PsA. Most patients with PsA (60%) also experienced issues related to their emotional wellbeing. Physical activity, sleep quality, functional independence, and the ability to perform daily activities were the most important disease impacts prioritized by patients.

Symptoms and improvements were similar across all patients, regardless of treatment with biologic disease-modifying antirheumatic drugs (bDMARDs).

While over half (57%) of patients were either somewhat or very satisfied with their current treatment, oral, once-daily medications were preferred by 38% of patients. The majority of participants (74%) favored therapies that offered significant joint-related symptom improvement versus psoriasis-related improvement.

Most (65%) were not interested in being treated with methotrexate.

The BWS did not provide an estimation of the level of importance for each symptom and its impact. Rheumatologists must discuss the impacts of PsA with each individual patient when creating a treatment plan. Further, the survey participants were mostly White, female, and well educated, so results may not be generalizable among other PsA patient populations. Lastly, as the survey was conducted through ArthritisPower, there may be a possibility of recruiting bias.

“Patients with PsA strongly desire a treatment option that could improve their daily function and generally prefer a daily, oral option as well as a treatment regimen that does not include a methotrexate co-prescription,” investigators concluded. “These findings can be used to facilitate future treatment decisions and treatment strategies.”

Reference:

Ogdie A, Myers K, Mansfield C, et al. Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry [published online ahead of print, 2022 Mar 13]. Rheumatol Ther. 2022;10.1007/s40744-022-00436-x. doi:10.1007/s40744-022-00436-x