Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries

RMD Open. 2022 May;8(1):e002031. doi: 10.1136/rmdopen-2021-002031.

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.

Keywords: Arthritis, Psoriatic; Epidemiology; Outcome Assessment, Health Care.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Psoriatic* / drug therapy
  • Cross-Sectional Studies
  • Delivery of Health Care
  • Female
  • Healthcare Disparities*
  • Humans
  • Male
  • Middle Aged
  • Remission Induction
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Antirheumatic Agents

Associated data

  • ClinicalTrials.gov/NCT03119805