Work

Beyond disease activity: patient-reported impact of disease states in psoriatic arthritis using PsAID-12 time-independent clustering

Year: 2026

Type: article

Abstract: Objectives The lived experience of psoriatic arthritis (PsA) is heterogeneous and not fully captured by conventional disease activity measures. This study aimed to identify data-driven patient-reported impact of disease states using the 12-item Psoriatic Arthritis Impact of Disease questionnaire (PsAID-12) responses and to assess their clinical relevance.Methods 5099 observations from 880 participants in the Dutch southwest Early Psoriatic Arthritis (DEPAR) cohort were analysed. Multiple clustering techniques were applied to PsAID-12 domain scores to derive impact states independently of time. The final clustering solution was selected based on cohesion, separation, stability under data perturbation and clinical interpretability. Clusters were characterised based on symptom/impact profiles and evaluated against clinical disease activity and established disease activity states (Disease Activity in PSoriatic Arthritis, Psoriatic Arthritis Disease Activity Score, Minimal Disease Activity, PsAID-12). Transitions between states were examined afterwards.Results Six impact of disease states were identified, ranging from very mild to pervasively severe burden. Among states with comparable impact severity, skin problems and psychosocial burden were the primary differentiators. Remission and low disease activity corresponded strongly with (very) mild impact clusters, whereas moderate and high disease activity showed wide dispersion across all clusters. Patients in extreme states showed greater temporal stability, while intermediate states exhibited greater transition dynamics, typically to adjacent clusters.Conclusion PsA comprises distinct lived-experience states not fully captured by traditional treatment targets. Patients with similar clinical disease activity may experience markedly different levels and types of impact. Findings highlight the importance of dermatological, emotional and social dimensions in addition to musculoskeletal inflammation. Integrating patient-reported symptom and impact assessments into routine evaluation may facilitate more tailored treatment strategies.

Source: RMD Open

DOI: 10.1136/rmdopen-2026-007126