Sustained target attainment in psoriatic arthritis: Predictors and barriers in a Chinese longitudinal cohort
Xinyi Hu, Wenhui Xie, Zhibo Song, Xiaohui Zhang, Yan Geng, Zhuoli ZhangBackground
The multidimensional clinical manifestations of PsA encompassing challenges to both the definition and consistent implementation of T2T in this population. A key hurdle is the lack of consensus regarding the optimal approach to disease activity assessment. Yet studies reveal considerable disparities in target attainment rates depending on the instrument used. To date, no longitudinal cohort data have been available on the attainment and sustainability of treatment targets among Chinese patients with PsA.
Objectives
Treat-to-target improves outcomes in psoriatic arthritis (PsA), but the optimal target definition and sustainability of disease control remain unclear. We therefore systematically compared five composite measures for assessing treatment target attainment and identified predictors of sustained disease control in a Chinese PsA cohort.
Design
This cross-sectional and retrospective cohort study, based on the PKUPsA cohort (2016–2024), compared five PsA response criteria (MDA, DAPSA, cDAPSA, DAS28-ESR, DAS28-CRP) at baseline and evaluated short-term and sustained attainment/remission over 12 months of follow-up, exploring predictors of sustained response.
Methods
Data from the Peking University First Hospital PsA (PKUPsA) cohort (enrolled 2016–2024) were analyzed. Baseline rates of target attainment were compared across five definitions: DAPSA, cDAPSA, DAS28-ESR, DAS28-CRP, and MDA. A longitudinal subcohort was followed for sustained treatment target attainment. Agreement between measures was evaluated with Cohen’s Kappa, and predictors of sustained attainment were identified via Cox regression.
Results
Among 419 patients (59.2% male, median age 49 years, disease duration 2 years), baseline target attainment varied significantly: 33.4% (MDA), 54.4% (DAPSA), 58.5% (DAS28-ESR), 62.1% (DAS28-CRP), and 62.5% (cDAPSA). Measure Agreement ranged from moderate to excellent (Kappa: 0.417–0.834). In DAPSA-but not MDA-attainers, pain VAS (82.1%) and PASI (77.9%) were the main limiting factors. In the longitudinal cohort (n=151), 6-month sustained treatment target attainment ranged from 35.1% (MDA) to 71.3% (cDAPSA), with marked declines over longer periods. Factors associated with faster sustained attainment included lower baseline disease activity (VAS ≤3, TJC68 ≤3, SJC66 ≤3, HAQ ≤1, CRP ≤5 mg/L, ESR ≤13 mm/h). For sustained remission, predictors included lower baseline TJC68, VAS, HAQ, CRP, and baseline csDMARD use.
Conclusion
In this first systematic evaluation of five composite measures for sustained targets in a Chinese PsA cohort, short-term success was achievable but long-term sustainability remained challenging. Lower baseline disease activity was associated with faster achievement of sustained targets, whereas baseline csDMARD use was associated with sustained remission; these observational associations should not be interpreted as evidence of therapeutic superiority. These findings support standardized, clinically feasible assessment strategies to improve PsA management.