Experiences and Treatment Preferences in Patients With Psoriatic Arthritis: A Cross-Sectional Study in the ArthritisPower Registry

Abstract

Introduction: Despite recent advances in treatment for psoriatic arthritis (PsA), many patients experience inadequate response or intolerance to therapy, indicating that unmet treatment-related needs remain. To further characterize these unmet needs, we evaluated patients' experiences regarding the burden of PsA symptoms and disease impacts, and patients' preferences for treatment.

Methods: Patients from ArthritisPower, a rheumatology research registry, completed a web-based survey. Object case best-worst scaling (BWS) was used to evaluate the relative burden of 11 PsA-related symptoms and the relative importance of improvement in nine PsA-related disease impacts. BWS data were analyzed using a random-parameters logit model. Patient demographics, preferences for mode and frequency of therapy, and preferences for methotrexate were analyzed descriptively.

Results: Among the 332 participants, most were White (94%), female (80%), with mean age of 54 years (SD 11.4). In the BWS, joint pain was the most bothersome symptom, followed by other musculoskeletal pain and fatigue. The BWS for disease impacts found that improvements in the ability to perform physical activities were most important, followed by improvements in the ability to function independently, sleep quality, and the ability to perform daily activities. The most burdensome symptoms and desired disease impact improvements were similar in patients regardless of their experience with biologic disease-modifying antirheumatic drugs. The most preferred mode and frequency of treatment administration was oral, once-daily medication (preferred by 38% of respondents), and 74% prioritized therapies that significantly improved joint-related symptoms versus psoriasis-related symptoms. The majority of respondents (65%) preferred PsA treatment regimens that did not include methotrexate.

Conclusions: Patients with PsA from a rheumatology registry found musculoskeletal pain symptoms to be the most bothersome and prioritized improvements to functional impacts of their disease. These findings can better inform development of new therapies and guide shared patient-provider treatment decision-making.

Keywords: Best–worst scaling; Disease impacts; Joint pain; Patient preferences; Psoriatic arthritis.

Fig. 1

Relative burden of PsA disease symptoms. PsA psoriatic arthritis. The relative burden estimates for the full sample from the symptom best–worst scaling exercise, where the most burdensome symptom, joint pain, is set to 10.0. For example, joint pain is 2.5 times more burdensome than joint swelling (10/4 = 2.5) and is almost as burdensome as lower back or spine pain (10.0/9.0 = 1.1)

Fig. 2

Relative importance of improving PsA disease impacts. PsA psoriatic arthritis. The scaled relative importance of improving PsA disease impacts, where the most important impact to improve is set to 10.0. For example, the ability to perform physical activities is approximately three times more important to improve than emotional well-being (10.0/3.1 = 3.2)

Fig. 3

Respondents’ preferences for mode and frequency of treatment administration

Fig. 4

Respondents’ preferences for a treatment improving joint versus skin symptoms