Common PsA Symptoms Negatively Impact Quality of Life

A study attempted to see how symptoms affect quality of life after adjusting for confounding factors.

The most common symptoms of psoriatic arthritis (PsA) have a negative impact on patients’ quality of life, a new study shows, suggesting a continuous need to lower the disease’s burden on patients.

People with PsA can experience a wide range of musculoskeletal and nonmusculoskeletal manifestations. The study authors noted that about 60% of patients with PsA will have more than 4 joints involved at presentation and 70% of patients will also have psoriasis. In addition, axial involvement is common, which they said can present as sacroiliitis and inflammatory back pain. Many patients with PsA will also have enthesitis, dactylitis, and nail dystrophies, they noted.

The many manifestations of PsA can significantly impair a person’s quality of life, but the investigators said there has been relatively little research looking into how individual manifestations of the disease affect patients’ quality of life.

In a new study in Joint Bone Spine, the investigators used data from a 2018 multinational, cross-sectional study of people with PsA to identify links between individual patients’ disease manifestations and their characterization of their quality of life. A total of 2222 people with PsA were included in the analysis. Of those, 77% had active psoriasis and 64.4% had peripheral arthritis, the authors noted. In addition, 5.9% of patients had enthesitis, 6.8% had dactylitis, 10.2% had inflammatory back pain, and 3.6% had sacroiliitis, they said.

To assess quality of life, the study used the EuroQol 5-Dimension 5-Level instrument, which includes the self-report-based EQ Visual Analogue Scale (EQ-VAS). On the EQ-VAS, a score of 0 represents the “worst imaginable health state” and a score of 100 represents the “best imaginable health state.”

The study investigators noted that people with enthesitis, dactylitis, and greater peripheral joint involvement all had worse EQ-VAS scores than patients without those symptoms. The biggest gaps were between patients with (mean score of 59.9) and without (mean score of 75.6) enthesitis and between those with no peripheral joint involvement (mean score of 82.5) and those with more than 6 joints affected (mean score of 65.0).

Similar findings came from the Psoriatic Arthritis Impact of Disease (PsAID) assessment, which found those factors and the total affected body surface area were associated with poorer scores. Two other qualify-of-life instruments also found similar results.

The authors said these results align with previous research, but they said their study bolsters the scientific community’s understanding of how PsA symptoms affect quality of life because they adjusted their findings to account for potential confounding factors.

“The present study has quantified the incremental impact of key manifestations of PsA on patient outcomes and underscores the importance of ameliorating enthesitis, dactylitis, and axial manifestations in addition to skin and peripheral joint involvement in routine clinical care to reduce the overall disease burden,” the authors concluded.

The authors said the wide variety of therapies available to patients with psoriasis is good news, but that it is important for physicians to understand that the disease manifestations that most negatively affect quality of life are very common.

“These results underscore the need to address the full spectrum of PsA manifestations during treatment,” they concluded.


Walsh JA, Ogdie A, Michaud K, et al. Impact of key manifestations of psoriatic arthritis on patient quality of life, functional status, and work productivity: findings from a real-world study in the United States and Europe. Joint Bone Spine. Published online January 24, 2023. doi:10.1016/j.jbspin.2023.105534

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