The impact of psoriatic arthritis on quality of life and lifestyle: a systematic review

Background/Aims Psoriatic arthritis (PsA) is a chronic inflammatory disease that affects adults of all ages. It is common for patients to experience a wide variety of physical and psychological problems. The objective of this systematic review was to determine how PsA impacts a person's quality of life (QoL). Methods A systematic literature search of CENTRAL, CINAHL, AMED, EMBASE, Global Health, MEDLINE and PsycINFO databases was conducted on 28th May 2021. Title, abstract and whole text screening, and data extraction were completed by two independent authors. The primary outcomes of this study were PsA activity and severity, impact of PsA on lifestyle and QoL. As per the protocol (PROSPERO CRD42021257395), studies which reported at least one of these primary outcomes were included. The quality assessment was conducted using the Joanna Briggs Institute Critical Appraisal criteria. Results Of the 20,316 papers identified by the search strategy, 42 papers which reported on at least one of the study primary outcomes were included in the review. 38 studies reported on PsA activity and severity, 26 on impact of PsA on lifestyle and 23 on QoL. 7 different measures were used to assess impact of PsA on lifestyle, including Health Assessment Questionnaire (HAQ) (n=13), modified HAQs (n=10), PsA impact of disease measure (n=2), functional capacity ACR (n=1), functional assessment of chronic illness therapy (n=1), Bath ankylosing spondylitis functional index (n=1) and a patient-directed question (n=1). 13 papers reported an average HAQ score between 0.13 and 1.3 for PsA participants. Two studies which reported HAQ disability index compared PsA participants to other groups. Thus, the impact of disease on lifestyle is worse for PsA compared to psoriasis, rheumatoid arthritis and healthy controls, psoriasis. DAPSA and PASI were the most used disease activity scores in addition to various patient-reported outcomes. The average DAPSA was 15.5, suggesting that the majority of PsA patients have moderate disease activity. Although the average PASI (skin) score showed mild disease among the PsA (3.82) group, a high PASI score was associated with late/never minimal disease activity and obesity. 8 different measures were used to assess QoL, including Psoriatic Arthritis Quality of Life (n=6, average), EQ-5D (n=4), EQ-3D (n=1), DLQI (n=7), SF-36 (n=3), SF-12 (n=1), WHOQOL-BREF (n=2), PSQI (n=1), Rosenberg Self-Esteem Scale (n=1) and Psoriasis disability index (n=1). Except for QoL for skin (DLQI), PsA was associated with worse outcomes in all these measures, in comparison with spondylarthritis, healthy control and psoriasis only groups. Conclusion PsA significantly affects a patient's life and health-related QoL. The degree of activity and severity of the disease have a substantial impact. Therefore, for patients with high disease activity, specific management plans should be discussed and facilitated to maintain their mobility and functional abilities. Disclosure L. James: None. R. Suribhatla: None. L.H. Hailey: None. R. Amarnani: None. C. Bundy: None. D. McGagh: None. S. Kirtley: None. D. O'Sullivan: None. I. Steinkoenig: None. L.C. Coates: None.