Psoriatic Arthritis and Burden of Disease: Patient Perspectives from the Population-Based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) Survey

Abstract

Introduction: Psoriatic arthritis (PsA) is underdiagnosed and has a substantial impact on quality of life, disability, and work productivity. The population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis (MAPP) survey examined the impact of PsA on patients' activities of daily living and unmet treatment needs.

Methods: This large-scale, random digit dialing, telephone survey of patients self-reporting a diagnosis of psoriasis and/or PsA was conducted in North America and Europe.

Results: In all, 3426 patients participated in the survey, including 712 (21%) who identified themselves as having PsA. Over half of the patients reported severe PsA involving more than four joints. Eighty-three percent of patients with PsA visited a health-care provider within the past 12 months. Approximately one-quarter saw their primary care provider or dermatologist most often for their disease; 37% responded that their rheumatologist was the health-care provider seen most often for PsA. Patients with PsA reported a substantial impact of disease on physical function. One-third of patients with PsA reported missing work because of their disease and PsA impacted their ability to work full time. Over half of the patients with PsA (58%) reported receiving no treatment or topical therapy only, leaving their joint disease untreated. Factors associated with lack of adherence were perceived lack of efficacy and concerns about long-term safety.

Conclusions: The MAPP survey confirms that PsA has a significant impact on physical function and activities of daily living. Undertreatment of PsA suggests a need for improved screening and diagnosis as well as education about treatment options and adherence.

Funding: Celgene Corporation.

Keywords: Burden of illness; Health survey; Psoriatic arthritis; Quality of life; Questionnaires; Treatment.

Fig. 1

Number of affected joints (a) and self-assessed severity (b) in patients with PsA. ^aIncludes only patients with PsA who reported joint pain (n = 628). PsA pssoriatic arthritis

Fig. 2

Impact of PsA on the 8-item Health Assessment Questionnaire and the proportion of patients responding “with much difficulty” or “unable to do” (a), and impact of psoriasis palm count on the 8-item Health Assessment Questionnaire in patients with PsA and the proportion of patients responding “with much difficulty” or “unable to do” (b). PsA psoriatic arthritis

Fig. 3

Impact of PsA on patients’ ability to function and work productively. ^aProportion of patients who responded with yes; all other responses represent the proportion of patients reporting “a lot” or “some” impact of PsA. PsA psoriatic arthritis

Fig. 4

The top five burdens associated with and reasons for discontinuation of conventional oral therapy (a, b) and biologic therapy (c, d)