Q&A: Determinants of Work, Social Participation in Patients With Psoriatic Arthritis

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In this Q&A, Tamara van Hal, MD, discussed the findings of her study that evaluated the extent of work and activity impairment in patients with psoriatic arthritis and examined determinants associated with this impairment.

In patients with psoriatic arthritis (PsA), worse physical function was associated with a lower likelihood of having paid work, along with a greater work and activity impairment. This is according to a study published in BMC Rheumatology, which also found that low disease activity(LDA) on the Psoriatic Arthritis Disease Activity Score (PASDAS) compared with LDA on the Disease Activity Score of 28 joints (DAS28-CRP) favored the reduction of work and activity impairment.1

The pain, disability and permanent joint damage associated with PsA can lead to impairments in work and social participation, but little is known about the extent of these impairments in routine practice. This observational study included data from the electronic health records of 246 patients (mean age 55.7 years, 51.2% female) with PsA treated at the Sint Maartenskliniek in Nijmegen, the Netherlands. Data about work and activity impairment were compared with age- and sex-matched data from the Dutch general population.

Compared with the Dutch general population, work-for-pay status was significantly lower in patients with PsA (52.9% vs 62.6%, P < 0.001). In patients with PsA, younger age and better physical function were associated with work-for-pay status (P < 0.05). Higher disease activity along with both worse physical function and mental health-related quality of life were associated with greater work and activity impairment (P < 0.05). Further, reaching LDA activity status according to PASDAS (≤ 3.2) was associated with less work and activity impairment than reaching LDA according to DAS28-CRP (≤ 2.9) (P < 0.05).

In this Q&A, corresponding investigator Tamara van Hal, MD, rheumatologist in training at Sint Maartenskliniek, discussed the research and its findings.

Rheumatology Network: What were the main findings?

Tamara van Hal, MD: In our PART2-study, we showed that in the Netherlands, people with PsA are less likely to be employed (or, have work-for-pay) than the general population. Moreover, we showed that in our cohort, which received state-of-the-art treatment and thus represents a "best possible situation" for PsA patients currently, there still is considerable impairment in daily-life, non-work activities. It is important for caregivers and regulatory bodies to be aware of these impairments.

RN: What is the current practice and how could the findings possibly change things?

TvH: We also showed that a higher disease activity (measured via PASDAS) is associated with worse self-reported work and activity performance. Moreover, being in remission according to the PsA-specific PASDAS gives a higher chance of a good outcome than being in remission according to DAS28.

These results imply that better disease control may lead to better performance outcomes, and that the use of the PsA-specific PASDAS could further improve a patient’s functioning when compared to using the DAS28. However, in current clinical practice, 28-joint counts such as the DAS28 are still often used to assess disease activity. Given the fact that we see a difference in impairment between patients in DAS28-based remission versus PASDAS-based remission, our advice would be to aim for the best possible disease control, using a PsA-specific diseases activity score.

RN: What are the takeaway points for clinicians?

TvH:I would like to urge clinicians and policymakers to keep in mind what it really means for a patient to have a chronic disease such as PsA, ie, what are the daily life problems (such as employment) that a patient experiences due to their disease, and to actively discuss these points with their patients.


van Hal, T.W., Mulder, M.L.M., Wenink, M.H. et al. Determinants of work and social participation in patients with psoriatic arthritis in the Netherlands: an observational studyBMC Rheumatol 6, 49 (2022).