Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries. Issue 1 (6th May 2022)

• Record Type: Journal Article
• Authors: Lucasson, Florian; Kiltz, Uta; Kalyoncu, Umut; Leung, Ying Ying; Palominos, Penélope; Canete, Juan; Scrivo, Rossana; Balanescu, Andra; Dernis, Emanuelle; Meisalu, Sandra; Ryussen-Witrand, Adeline; Soubrier, Martin; Aydin, Sibel Zehra; Eder, Lihi; Gaydukova, Inna; Lubrano, Ennio; Richette, Pascal; Husni, Elaine; Coates, Laura C; de Wit, Maarten; Smolen, Josef S; Orbai, Ana-Maria; Gossec, Laure
• Is Part Of: RMD open. Volume 8:Issue 1(2022)
• Publication Date: 2022-05-06
• Subjects: Arthritis, Psoriatic -- Outcome Assessment, Health Care -- Epidemiology; Musculoskeletal system -- Diseases -- Periodicals; Rheumatism -- Periodicals; 616.7005
• DOI: 10.1136/rmdopen-2021-002031
• Languages: English
• ISSNs: 2056-5933

Abstract

Abstract : Objectives: Patient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments. Methods: A cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805 ) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA >14) and no ongoing bDMARD prescription. Results: In 439 patients (50.6% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity and disease impact were higher in the lowest GDP/capita countries. DAPSA remission and MDA were attained in the lowest tertile in 7.0% and 18.4% patients, vs 29.1% and 49.5% in the middle tertile and 16.8% and 41.3% in the high tertile, respectively (all p<0.001). bDMARDs use was similar in the tertiles (overall mean 61%). The overall rate of patients with DAPSA >14 and no bDMARDs was 18.5%, and was higher in lower GDP/capita countries (p=0.004). Conclusion: PsA patients from countries with the lowest GDP/capita, despite similar use of bDMARDs, were more likely to have high disease activity and worse disease impact. There is a need for more equity in healthcare.