Achieving minimal disease activity in psoriatic arthritis in therapeutic practice

The purpose — to identify and analyze the minimal disease activity (MDA) domains in psoriatic arthritis (PsA) most difficult to achieve in clinical practice. Material and methods. The research included 114 adult patients with PsA who were admitted to the Republican Clinical Diagnostic Center and assessed for compliance with the MDA criteria. Results. The MDA was identified in 5 (4.4%) patients. The most common domains that prevented to achieve MDA were: patient’s assessment of disease activity (112 (98.2%) patients assessed disease activity as > 20 mm), pain by the visual analogue scale (106 (92.3%) patients noted pain as > 15 mm), and tender joints (2 or more tender joints were detected in 95 (83.3%) patients). The MAD domains less difficult to achieve were: swollen joints (2 or more swollen joints were detected in 75 (65.8%) patients), HAQ-DI questionnaire (HAQ-DI > 0.5 points were determined in 64 (56.1%)), psoriasis (PASI > 1% and BSA > 3% were detected in 62 (54.4%)), and enthesitis (LEI index > 1 point was determined in 20 (17.5%) patients). Conclusions. The study showed that the MDA domains most difficult to achieve in patients with PsA were the «controlled by the patient» domains that depend on the patient’s opinion of their somatic status. Better controllability was observed for «objective» domains (psoriasis, swollen joints, enthesitis). The patient’s assessment of disease activity and perception of condition are influenced by many factors, including anxiety-depressive disorders, psychological and social difficulties, fatigue, tiredness, chronic pain, persistent impairment of functional capabilities, and irreversible structural conditions.