Tuesday, June 20, 2017

DAPSA at the 2017 EULAR Annual Meeting in Madrid

The DAPSA [disease activity in psoriatic arthritis] is relatively new, but is already widely used; and not only in studies that bear the name of J.S. Smolen [1,2], whom we should be indebted for promoting disease activity indices for different rheumatic diseases.

P.J. Mease and collegues presented the following study [3]: “CORRELATION OF THE ROUTINE ASSESSMENT OF PATIENT INDEX DATA (RAPID-3) WITH OTHER PSORIATIC ARTHRITIS COMPOSITE DISEASE ACTIVITY MEASURES IN PATIENTS”. They used data from the ADEPT trial in this post hoc analysis. “Correlations between RAPID-3 and DAPSA over time were assessed through Pearson and Spearman coefficient.” Conclusions: “In a PBO-controlled trial of ADA in pts with PsA, there was
good correlation between disease activity captured by pt’s self-assessment, via
the RAPID-3, and physician assessment, underscoring the potential utility of
pt-derived measures in assessing disease activity.”

L.C. Coates an colleagues presented [4]: “COMPARISON OF DIFFERENT REMISSION TARGETS IN PATIENTS WITH PSORIATIC ARTHRITIS AND EVALUATION OF THEIR PROGNOSTIC VALUE”. “Remission was investigated for disease activity index for PsA for 3 definitions: very low disease activity (VLDA), Disease Activity in PsA (DAPSA), and clinical (c)DAPSA.” Conclusions: “VLDA remission is a more stringent target than DAPSA and cDAPSA remission, with the advantage of including a measurement for psoriasis.”

The DAPSA is easily calculated. You count painful and swollen joint (out of 68), measure CRP in mg/dl, have the patient indicate the average disease activity and pain during the past seven days [0-10]. Then you add up. 0-4 remission, 5-14 low, 15-28 mean, >28 high disease activity. 68 joints take more time than 28 joints in the DAS28. Why not take CRP in mg/l? Or even better ESR, which doesn’t change as quickly as CRP?

With all criticism I think it’s a useful tool and I’ll try how it works in clinical practice.

Links and References: 
[1] DOI: 10.1136/annrheumdis-2017-eular.2835
[2] DOI: 10.1136/annrheumdis-2017-eular.3762
[3] DOI: 10.1136/annrheumdis-2017-eular.1952
[4] DOI: 10.1136/annrheumdis-2017-eular.1188


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