Lessons learned from clinical phenotypes in early psoriatic arthritis: the real-world Dutch south west Early Psoriatic ARthritis study

Figures & data

Figure 1. Data flow of the Dutch south west Early Psoriatic ARthritis (DEPAR) study: patient-reported outcomes (PROs), clinical data, laboratory data, and medication from the hospital’s electronic patient records were collected and integrated

Table 1. Demographic characteristics of the Dutch south west Early Psoriatic ARthritis (DEPAR) study cohort (n = 527)

Demographic characteristics	Total	Monoarthritis	Oligoarthritis	Polyarthritis	Enthesitis	Axial	Dactylitis
Number of patients	527 (100)	80 (15)	210 (40)	119 (23)	54 (10)	13 (2)	51 (10)
Age (years)	50.2 ± 13.5	48.1 ± 14.2	48.9 ± 13.5	56.1 ± 13.5	49.5 ± 8.5	47.4 ± 12.0	46.3 ± 13.2
Male	255 (48)	37 (46)	117 (56)	50 (42)	15 (28)	5 (38)	31 (61)
Duration of complaints (months)*	11.0 (3.8–32.6)	8.2 (2.8–25.6)	10.4 (3.9–32.5)	9.0 (3.6–34.5)	28.1 (15.1–97.7)	21.8 (9.3–25.0)	7.6 (2.4–25.9)
Positive family history, first degree*	261 (50)	46 (58)	100 (48)	57 (48)	29 (54)	6 (46)	23 (45)
Smoking†
Current	98 (22)	13 (20)	48 (27)	18 (18)	14 (30)	2 (20)	3 (7)
Past	197 (44)	26 (40)	78 (43)	49 (48)	15 (32)	5 (50)	24 (53)
Never	154 (34)	26 (40)	54 (30)	35 (34)	18 (38)	3 (30)	18 (40)
Alcohol consumption > 1 unit a week‡	184 (35)	22 (34)	77 (43)	44 (43)	18 (38)	2 (20)	21 (47)
Patients with 1 year follow-up
Possible	456 (87)	76 (95)	178 (85)	99 (83)	48 (89)	11 (85)	44 (86)
Actual, n (% of possible)	355 (78)	59 (78)	136 (76)	81 (82)	35 (73)	8 (73)	36 (82)

Data are shown as n (%), mean ± sd, or median (interquartile range).

*Data missing for four patients.

†Data missing for 78 patients (15%).

‡Data missing for 78 patients (15%).

Table 2. Clinical characteristics of the Dutch south west Early Psoriatic ARthritis (DEPAR) study cohort (n = 527)

Clinical characteristics	Total	Monoarthritis	Oligoarthritis	Polyarthritis	Enthesitis	Axial	Dactylitis
Number of patients	527 (100)	80 (15)	210 (40)	119 (23)	54 (10)	13 (2)	51 (10)
BMI (kg/m^2)	28.3 ± 5.2	28.3 ± 5.8	28.5 ± 5.2	28.0 ± 4.6	28.5 ± 4.9	28.2 ± 3.5	27.9 ± 5.8
66/68 joint count (swollen/tender)	2/3 (0–4/1–7)	1/2(0–1/1–5)	2/3(1–4/2–7)	6/7 (3–9/3–12)	0/2 (0–1/1–6)	0/1 (0–1/0–2)	1/1 (0–2/0–3)
Enthesitis at clinical examination
LEI > 0	217 (41)	38 (48)	84 (40)	41 (34)	35 (65)	6 (46)	13 (25)
LEI in case of enthesitis	1 (1–3)	1 (1–2)	2 (1–2)	1 (0–3)	2 (1–4)	2 (1–4)	1 (1–2)
MASES > 0	188 (36)	26 (33)	70 (33)	39 (33)	35 (65)	4 (31)	14 (27)
MASES in case of enthesitis	2 (1–3)	1 (0–2)	1.5 (0–2)	1 (0–2)	2 (1–3)	1 (0–4)	2 (1–3)
Dactylitis present	113 (21.4)	11 (13.8)	47 (22.4)	21 (17.6)	2 (3.7)	2 (15.4)	30 (58.8)
Psoriasis
PASI = 0	83 (16)	15 (19)	32 (15)	16 (13)	8 (15)	5 (38)	7 (14)
PASI score in case PASI > 0	2.6 (1–4.7)	2.6 (1.2–4.2)	2.8 (0.8–4.7)	2.7 (1.6–5.4)	1.4 (0.6–3.1)	2.6 (1.5–7.3)	2.6 (0.8–3.8)
PASI > 10	27 (5)	1 (1)	13 (6)	8 (7)	3 (6)	1 (8)	1 (2)
Elevated CRP*	130 (31)	11 (18)	56 (32)	39 (43)	10 (21)	2 (18)	12 (29)
VAS score (mm) by research nurse
Psoriasis	10 (3–24)	10 (2–19)	11 (3–25)	12 (3–31)	5 (2–14)	11 (1–29)	7 (2–13)
Joints	14 (5–27)	10 (5–16)	17 (6–27)	29 (17–48)	3 (1–9)	5 (1–16)	9 (2–17)
Global	20 (10–35)	15 (9–23)	22.5 (12–36)	33.5 (22–50)	8 (3–19)	8 (6–26)	12 (6–27)

Data are shown as n (%), mean ± sd, or median (interquartile range).

*According to cut-off values of the hospital. Data missing for 103 patients (20%).

BMI, body mass index; LEI, Leeds Enthesitis Index; MASES, Maastricht Ankylosing Spondylitis Enthesitis Score; PASI, Psoriasis Area and Severity Index; CRP, C-reactive protein; VAS, visual analogue scale.

Table 3. Patient-reported outcomes according to clinical phenotype

Patient-reported outcome	Range of sumscore	Total	Monoarthritis	Oligoarthritis	Polyarthritis	Enthesitis	Axial	Dactylitis
Number of patients		527 (100)	80 (15)	210 (40)	119 (23)	54 (10)	13 (2)	51 (10)
Symptoms
Pain (VAS)	0–100	47.1 ± 26.1	39.3 ± 25.6	50.2 ± 26.5	49.6 ± 28.1	48.4 ± 20.3	44.8 ± 28.8	39.9 ± 23.6
Fatigue
No fatigue (% reporting 0)		36 (9)	3 (5)	19 (11)	8 (8)	0 (0)	1 (8)	5 (12)
BRAF score per dimension in case of NRS fatigue > 0
Physical fatigue	0–22	12.2 ± 5.5	10.9 ± 6.1	12.5 ± 5.4	12.4 ± 5.5	14.3 ± 4.0	13.3 ± 5.6	9.6 ± 5.6
Living with fatigue	0–21	4 (1–7)	3 (1–7.5)	4 (1–7)	5 (1–7)	5 (2–9)	6 (1–8)	2 (0–4)
Cognitive fatigue	0–15	3 (0–5)	2 (0–5)	3 (0–5)	3 (0–5)	5 (2.5–6)	2 (1–5)	2 (0–4)
Emotional fatigue	0–12	1 (0–3)	1 (0–3)	1 (0–4)	1 (0–3)	2.5 (1–4)	0 (0–4)	0 (0–2)
Total score	0–70	21.5 ± 14.4	19.4 ± 14.6	21.5 ± 14.6	22.1 ± 14.7	27.5 ± 11.7	24.1 ± 13.5	15.2 ± 13.3
Skin
Impact of psoriasis on daily life
VAS	0–100	22 (5–46)	17 (2–43)	23 (6–46)	24 (9–49)	17 (3–46)	22 (5–62.5)	20 (6–42)
Skindex-17 – Symptoms	0–10	4 (2–6)	4 (1.5–5)	4 (2–5)	4 (2–6)	4 (2.5–6.5)	4 (0.5–5.5)	3 (1–5)
Skindex-17 – Psychosocial	0–24	2 (0–7)	1.5 (0–6)	2 (0–8)	2 (0–8)	1 (0–7)	1.5 (0–4)	1 (0–7)
Disease impact and physical functioning
Impact of psoriasis and joint inflammation on daily life (VAS)	0–100	45.6 ± 25.8	39.2 ± 25.1	45.5 ± 25.4	48.9 ± 26.3	48.5 ± 25.1	56.6 ± 26.2	41.1 ± 26.6
Impact of joint inflammation on daily life (VAS)	0–100	46.9 ± 26.9	39.6 ± 25.1	47.3 ± 25.9	50.7 ± 27.3	46.6 ± 29.1	58.9 ± 27.8	43.5 ± 27.7
Impact of PsA	0–10	3.7 ± 2.3	3.2 ± 2.3	3.9 ± 2.2	3.8 ± 2.3	3.8 ± 2.1	4.2 ± 2.5	3.0 ± 2.4
Daily functioning	0–3.0	0.8 (0.4–1.1)	0.6 (0.1–1.1)	0.8 (0.4–1.1)	0.9 (0.6–1.4)	0.8 (0.5–1.1)	0.6 (0.4–1.3)	0.5 (0.1–0.9)
Anxiety and depression
Anxiety score	0–21	4 (2–7)	5 (1–7)	4.5 (2–7)	4 (2–7)	5 (3–11)	3.5 (3–7)	4 (2–5)
Anxiety score ≥ 8		81 (19)	10 (16)	32 (19)	18 (18)	15 (33)	2 (17)	4 (10)
Depression score	0–21	3 (1–7)	3 (1–5)	3 (1–7)	3 (1–7)	4 (1–8)	2 (1–4)	2 (1–4)
Depression score ≥ 8		73 (17)	10 (16)	30 (17)	17 (17)	10 (22)	1 (8)	5 (12)
Quality of life
General
Health assessment
SF-36 – Physical component scale	0–100	39.1 ± 8.6	39.9 ± 9.1	39.2 ± 8.4	38.0 ± 8.5	37.8 ± 7.9	37.1 ± 5.1	42.3 ± 9.6
SF-36 – Mental component scale	0–100	47.8 ± 10.4	48.7 ± 9.3	47.5 ± 10.4	47.7 ± 11.2	45.4 ± 11.0	49.1 ± 9.5	50.9 ± 8.9
EQ-5D Index Score	0–1	0.78 (0.65–0.85)	0.79 (0.68–0.85)	0.77 (0.63–0.85)	0.74 (0.61–0.82)	0.75 (0.66–0.80)	0.75 (0.40–0.82)	0.82 (0.78–0.89)
PsA-specific
Quality of life	0–20	4 (1–10)	3 (0–9)	4 (1–10)	5 (2–9)	6.5 (3–11)	7 (2–11)	1 (0–6)

Data are shown as n (%), mean ± sd, or median (interquartile range).

VAS, Visual Analogue Scale; BRAF, Bristol Rheumatoid Arthritis Fatigue; NRS, Numeric Rating Scale; PsA, psoriatic arthritis; SF-36, 36-item Short Form Health Survey; EQ-5D, EuroQol 5 Dimensions.

Table 4. Work productivity according to phenotype among patients of working age (< 66 years; n = 453)

Patient-reported outcome
iPCQ
Productivity	Total (n = 386*)	Monoarthritis (n = 57)	Oligoarthritis (n = 156)	Polyarthritis (n = 72)	Enthesitis (n = 48)	Axial (n = 11)	Dactylitis (n = 42)
Number of patients working, n (%)	268 (69)	42 (74)	114 (73)	43 (60)	28 (58)	8 (73)	33 (79)
Workdays per week	5 (4–5)	5 (4–5)	5 (4–5)	5 (4–5)	4.5 (4–5)	5 (4–5.5)	5 (4–5)
Days with productivity loss	5 (0–10)	5 (2–10)	5 (0–10)	5 (0–14)	5 (2–10)	11 (4–16)	4 (0–10)
Amount of productivity on days that productivity was hampered)†	0.8 (0.7–0.9)	0.9 (0.7–1)	0.8 (0.7–0.9)	0.8 (0.6–0.9)	0.7 (0.5–0.8)	0.9 (0.8–1)	0.8 (0.7–1)
% Productivity loss at work over 4 weeks	3 (0–15)	0 (0–10)	3.5 (0–15)	4 (0–15)	7.5 (0–22)	4.5 (0–17)	0.5 (0–8)
Short-term sick leave (> 1 day per 4 weeks), %‡	17	20	16	12	21	50	9
Long-term sick leave (> 4 weeks), %‡	4	7	4	5	0	0	3

Data are shown as median (interquartile range), unless otherwise indicated.

*Data missing for 74 patients (17%) .

†Data of 189 patients.

‡Percentages are mutually exclusive.

iPCQ, iMTA Productivity Cost Questionnaire.