Relationship between clinical variables and Patient-Reported Outcomes in patients with psoriatic disease

Background Psoriatic Arthritis (PsA) is a chronic inflammatory form of Arthritis associated with enthesitis, dactylitis, nail dystrophy, uveitis, and osteitis. PsA is strongly associated with comorbidities such as obesity, metabolic syndrome, and cardiovascular disease. As usual PsA patients are assessed either by rheumatologist or dermatologist but a multiprofessional assessment for those subjects is important to improve their disease control and their quality-of-life. The multidimensional assessment is a new model of care for PsA patients in which a multiprofessional team (rheumatologist, dermatologist, internal medicine physician, nutritionist and a phycologist) with a nurse as case manager, assess patients in the main domains of PsA from the admission to the follow-up. Different validated tools are used by the team to assess different patients’ dimension as patient-reported-outcomes. This study aimed to evaluate the association between and among clinical variables and Patient-Reported Outcomes in a realworld sample of PsA patients evaluated according the Multidimensional Assessment. Methods A cross-sectional study was conducted. Patients with PsA who signed the informed consent were enrolled at the PsA clinic at the ARNAS Civico in Palermo (Italy) from March 2018 to October 2020. Clinical, pharmacological, anthropometric, laboratory variables, and patientreported outcomes were evaluated, including: • Health Assessment Questionnaire (HAQ); • Facit-Fatigue (FACIT-F); • Psoriatic Arthritis Impact of Disease Questionnaire (PsAID); • Patient Health Questionnaire-9 (PHQ-9); • Disease Activity in PSoriatic Arthritis score (Dapsa); • Patient global assessment (PGA) STATA 14.1 was used to perform logistic analysis. Results According to CASPAR Criteria, 158 patients aged 55.2 (53.3 – 57.1) affected by Psoriatic Arthritis were included in the study. All the collected variables were evaluated ad a strong association was observed between functional disability measured by HAQ >2 and central obesity [OR (95% CI) 16.94 (2.22 - 129.48); p < 0.004]. Moreover, data analysis showed an association between high impact of disease on life (PsAID >4) and central obesity [OR (95% CI) 3.33 (1.56 - 7.13); p<0,002]. Models were adjusted for age, sex, years of illness, and biological treatment. Conclusion This study demonstrated a high association between functional disability studied subjectively using the HAQ, the impact of the disease on patients’ quality-of-life using the PsAID, and central obesity in patients affected by PsA. Data suggest that a multiprofessional evaluation for these patients is important to evaluate different aspect of the disease as the comorbidities. In particular, therapeutic goals should not be focused only on treatment but also on waist circumference reduction to reduce inflammation and improve patients’ functional ability and quality-of-life.