Impact of Physician-Defined Flares on Quality of Life and Work Impairment: An International Survey of 2,238 Psoriatic Arthritis Patients

Objective To describe psoriatic arthritis (PsA) flares and their impact on patient-reported outcomes (PROs). Methods Cross-sectional surveys of rheumatologists/dermatologists and their PsA patients were conducted in France, Germany, Italy, Spain, the United Kingdom, and the United States, capturing data on physician-reported patient flare status, demographics, PsA severity and clinical outcomes. Patient-completed surveys captured data on PROs: quality of life (QoL) (EuroQol 5-dimension 5-level questionnaire [EQ-5D-5L]), Work Productivity and Activity Impairment (WPAI), Health Assessment Questionnaire-Disease Index (HAQ-DI) and Psoriatic Arthritis Impact of Disease 12-item questionnaire (PsAID12). Patients were compared by flare status using parametric and non-parametric tests. Multivariate regression was used to identify flare associations. Multivariate logistic regression adjusted for patient demographics and physician specialty assessed the impact of flare status. Results Among 2,238 patients (586 US, 1,652 Europe) from 572 physicians, physician-reported flare was present for 168 (7.5%) of patients, and self-reported flare was present for 95 (10.0% of available data) of patients. Mean flare count over 12 months was 2.2 (standard deviation, SD=4.9), lasting on average 16.4 (SD=16.2) days. Flare status was linked to worse PROs. Patients who had not flared in the last 12 months or had never flared had a higher QoL, lower overall work impairment, and a lower degree of disability compared with patients that were currently flaring (all, p<0.01). Conclusion Being in flare adversely impacted QoL, disability, and work productivity. PsA flares should be routinely assessed and managed in clinical care.