Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Application of Composite Disease Activity Scores in Psoriatic Arthritis to the PRESTA Dataset.
FitzGerald3, Oliver M., Helliwell5, Philip, Mumtaz4, Aizad, Coates5, Laure, Pedersen2, Ronald, Molta1, Charles T.
A number of rheumatoid arthritis composite disease activity indices have been used in clinical trials in psoriatic arthritis (PsA). Two composite disease activity measures have recently been proposed for PsA, but further validation is required. The purpose of this study is to compare the performance of the Composite Psoriatic Disease Activity Index (CPDAI) and the Disease Activity Index for Psoriatic Arthritis (DAPSA) in the PRESTA dataset, a large (N=752) randomised, double-blind, two-period study which evaluated the safety and efficacy of 2 doses of etanercept in the first study period on skin and joint disease in psoriasis subjects with active PsA.
Using the data obtained from the PRESTA study, the components of the CPDAI (4 domains, including joints [66 swollen/68 tender joint counts; HAQ]; skin [PASI; DLQI]; dactylitis [each digit rated 0 to 3]; and enthesitis [number of tendons showing enthesitis, 04, based on Achilles tendons and plantar fasciae bilaterally] and the DAPSA (patient global; pain assessment; 66/68 swollen and tender joint counts; and C-reactive protein [CRP]) were extracted. The performance of the scores at baseline and follow-up (weeks 12 and 24) was compared and also between the 2 treatment schedules (etanercept 50 mg QW v 50 mg BIW). Spearman correlations and both univariate and stepwise regression analyses were also used.
Both CPDAI and DAPSA could distinguish response to treatment comparing baseline and 12- or 24-week values (<0.0001). CPDAI, and not DAPSA, could distinguish response in the 2 treatment groups at 12 weeks (p=0.0492) but not at 24 weeks. All domains contributed to the data variability of the CPDAI, with dactylitis (r=0.64) and enthesitis (r=0.60) the most significant. Joint scores (SJC: r=0.8; TJC: r=0.91) contributed most to the variability in DAPSA. For change in CPDAI from baseline, stepwise regression revealed that change in enthesitis, DAS28, HAQ, dactylitis and DLQI were most significantly associated. For change in DAPSA, change in all of the 5 components were significantly associated.
Both CPDAI and DAPSA are effective in determining treatment response in patients treated with etanercept for active psoriasis and psoriatic arthritis. Joint responses were equally reflected by both composite scores but CPDAI, which better reflects other domains such as skin, enthesitis and dactylitis, is the only composite score which can distinguish global treatment response between the 2 etanercept doses.
To cite this abstract, please use the following information:
FitzGerald, Oliver M., Helliwell, Philip, Mumtaz, Aizad, Coates, Laure, Pedersen, Ronald, Molta, Charles T.; Application of Composite Disease Activity Scores in Psoriatic Arthritis to the PRESTA Dataset. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :514