Impact of Physician-Defined Flares on Quality of Life and Work Impairment: An International Survey of 2,238 Psoriatic Arthritis Patients

OBJECTIVE: To describe psoriatic arthritis (PsA) flares and their impact on patient-reported outcomes (PROs).

METHODS: Cross-sectional surveys of rheumatologists/dermatologists and their PsA patients were conducted in France, Germany, Italy, Spain, the United Kingdom, and the United States, capturing data on physician-reported patient flare status, demographics, PsA severity and clinical outcomes. Patient-completed surveys captured data on PROs: quality of life (QoL) (EuroQol 5-dimension 5-level questionnaire [EQ-5D-5L]), Work Productivity and Activity Impairment (WPAI), Health Assessment Questionnaire-Disease Index (HAQ-DI) and Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID12). Patients were compared by flare status using parametric and non-parametric tests. Multivariate regression was used to identify flare associations. Multivariate logistic regression adjusted for patient demographics and physician specialty assessed the impact of flare status.

RESULTS: Among 2,238 patients (586 US, 1,652 Europe) from 572 physicians, physician-reported flare was present for 168 (7.5%) of patients, and self-reported flare was present for 95 (10.0% of available data) of patients. Mean flare count over 12 months was 2.2 (standard deviation, SD=4.9), lasting on average 16.4 (SD=16.2) days. Flare status was linked to worse PROs. Patients who had not flared in the last 12 months or had never flared had a higher QoL, lower overall work impairment, and a lower degree of disability compared with patients that were currently flaring (all, p<0.01).

CONCLUSION: Being in flare adversely impacted QoL, disability, and work productivity. PsA flares should be routinely assessed and managed in clinical care.