Multidomain Disease More Common, Linked to Worse Outcomes in Psoriatic Arthritis


For patients with psoriatic arthritis (PsA), multidomain disease was associated with worse measures of disease activity, quality of life, and work productivity.

In psoriatic arthritis (PsA), multidomain disease was associated with worse measures of disease activity, quality of life (QOL), and work productivity, according to real-world US cohort study. Moreover, most patients had multidomain disease presentations in this study, which was published in the Journal of Rheumatology.1

“Because the frequency, type, and severity of the disease domains may affect treatment effectiveness and disease outcomes, careful consideration of the disease domain by the clinician may be critical for choosing the appropriate treatment,” explained Alexis Ogdie, MD, MSCE, of the University of Pennsylvania in Philadelphia, and colleagues. “There are limited real-world studies examining disease domain presentation among patients with PsA.”

In this cross-sectional observational study, the researchers aimed to describe the epidemiology and patterns of disease domain presentations among adults with PsA enrolled in the Corrona PsA/Spondyloarthritis Registry, from March 2013 to August 2018. They investigated the association of PsA symptoms, QOL, and work productivity among patients with single-domain versus multidomain disease presentation, comprising 2 or more of the following: enthesitis, dactylitis, peripheral arthritis, nail psoriasis, axial disease, and skin disease. The researchers also characterized disease presentations among 354 patients who initiated a biologic therapy at the time of enrollment.

Of the 2617 patients, 64.9% had multidomain presentations and 23.6% had single-domain presentations, while 11.5% had no active disease features. Of the 354 biologic initiators, 81.6% had multidomain presentations, 12.7% had single-domain presentations, and 5.6% had no active disease features. Overall, the most common single-domain and multidomain presentations were skin disease and peripheral arthritis plus skin disease, respectively.

Patients with multidomain disease were more likely to have psoriasis, nail psoriasis, depression, fibromyalgia, anxiety, and a history of biologic use compared with patients with single-domain presentations (all P < 0.05).

“Multidomain presentations were associated with significantly worse patient and physician global assessments of disease activity, pain, and fatigue,” the authors stated. “Additionally, multidomain presenters were more likely to have worse physical function as measured by Health Assessment Questionnaire– Disability Index (HAQ-DI), QOL as measured by the EuroQol 5-dimensions questionnaire (EQ-5D) and EQ VAS scores, and work and activity impairment as assessed by the WPAI questionnaire, respectively, than patients with single-domain presentations.”

The authors noted that as the data source was a US registry in which clinician investigators enroll their patients, the results may not be generalizable to all patients with PsA. They suggested that future studies build on these results to identify clusters of domains that may affect response to individual therapies.


Ogdie A, Hur P, Liu M, et al. Effect of Multidomain Disease Presentations on Patients With Psoriatic Arthritis in the Corrona Psoriatic Arthritis/Spondyloarthritis Registry. J Rheumatol. 2021;48(5):698-706. doi:10.3899/jrheum.200371

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