You are here

Article Text

Article menu
Rheumatology
Original research
Effects of bDMARDs on quality of life in patients with psoriatic arthritis: meta-analysis
  1. Yuqiong Lu,
  2. Zhanjing Dai,
  3. Yun Lu,
  4. Feng Chang
  1. School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
  1. Correspondence to Dr Feng Chang; cpucf{at}163.com

Abstract

Objectives To determine the effects of biological disease-modifying anti-rheumatic drugs (bDMARDs) on the quality of life (QoL) among patients with psoriatic arthritis (PsA).

Design Meta-analysis.

Data sources and eligibility criteria PubMed, Web of Science, Cochrane Library, China National Knowledge Infrastructure, WanFang and VIP databases were searched to collect randomised controlled trials (RCTs), which were conducted to evaluate the effect of bDMARDs in the treatment of patients with PsA and reported QoL-related outcomes, from inception to November 2020 and updated on 19 February 2022.

Data extraction and synthesis Outcomes about Health Assessment Questionnaire Disability Index (HAQ-DI), Dermatology Life Quality Index, physical component summary and mental component summary of the Short Form 36, EuroQol Visual Analogue Scale, Psoriasis Area Severity Index (PASI) 50/75/90/100 were extracted by two reviewers independently. Data were pooled using the fixed or random effects methods and considered as mean difference (MD) or risk ratio with 95% CI.

Results Out of 3190 articles screened, 37 RCTs (with 47 articles reported) were included. Pooled estimates showed that bDMARDs were superior versus placebo on all outcomes. Against methotrexate (MTX) and tofacitinib, bDMARDs showed no statistically significant advantages or significant disadvantages. Similar results were found for bDMARDs+MTX versus MTX. For HAQ-DI, the results of the subgroups of bDMARDs versus placebo, bDMARDs+MTX versus MTX, bDMARDs versus tofacitinib and bDMARDs versus MTX were −0.21 (MD, 95% CI, −0.23 to –0.18), −0.22 (MD, 95% CI, −0.58 to 0.14), –0.01 (MD, 95% CI, −0.05 to 0.04) and –0.03 (MD, 95% CI, −0.04 to –0.02), respectively.

Conclusions Compared with placebo, bDMARDs taken by patients with PsA appear to significantly improve the QoL. Compared with other therapeutic agents, more studies are required to confirm the effect of single and combined bDMARDs use further.

  • psoriasis
  • immunology
  • quality in health care

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjopen-2021-058497

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Strengths and limitations of this study

    • This is the first meta-analysis focusing on the effects of biological disease-modifying anti-rheumatic drugs (bDMARDs) on the quality of life among patients with psoriatic arthritis (PsA).

    • Subgroup analyses with the specific hierarchical structure were conducted to determine the source of heterogeneity, according to the experimental groups and control groups first, then category of bDMARDs, variety of bDMARDs, duration of PsA.

    • Meta-analysis was not performed for the outcomes reported in less than 3 randomised controlled trials (RCTs), and funnel charts were not drawn for the outcomes reported in less than 10 RCTs.

    • The results of Egger’s test indicated the presence of publication bias, but the trim and fill method was not used to explore publication bias.

    • There was a lack of stratification for countries or regions and long-term effects (exceeding 24 weeks) of bDMARDs for specific analysis due to the limited clinical data.

    Introduction

    Psoriatic arthritis (PsA) is a chronic inflammatory musculoskeletal disease that can lead to structural damage and disability, resulting in impaired quality of life (QoL), physical function and working ability.1–3 Scotti et al analysed the results of 28 studies and found that the prevalence and incidence rates of PsA are respectively 133 per 1 00 000 subjects and 83 per 100 000 person-years.4 PsA develops in up to 30% of patients with psoriasis.5 Rosen et al reported that the QoL of patients with PsA is significantly lower than that of patients with psoriasis.6 Therefore, one of the main objectives of treating PsA is to improve the QoL of patients. Currently, the QoL of patients with PsA can be measured by questionnaires including the Short Form 36 (SF-36) Questionnaire, Health Assessment Questionnaire (HAQ), Nottingham Health Profile (NHP), EuroQoL 5 domains (EQ-5D), Psoriasis Area and Severity Index (PASI), Disease Activity for Psoriatic Arthritis (DAPSA), Psoriasis Disability Index (PDI), Dermatology Life Quality Index (DLQI), Skindex-29, Skindex-17, Psoriasis Arthritis Quality of Life (PsAQoL).7–10 Among these questionnaires, the higher scores of SF-36 and EQ-5D indicate higher levels of QoL, while others are the opposite.11–16

    As a great advancement in the treatment of PsA, biological disease-modifying anti-rheumatic drugs (bDMARDs) have been proven to decrease inflammation and block structural progression effectively.17 18 The bDMARDs are widely recommended by management guidelines,1 19 including tumour necrosis factor inhibitors (TNFi, eg, etanercept, infliximab, adalimumab, golimumab, certolizumab pegol), interleukin-17 inhibitors (IL-17i, eg, ustekinumab, guselkumab, risankizumab) and interleukin-12/23 inhibitors (IL-12/23i, eg, secukinumab, ixekizumab, brodalumab).1 20 Ruyssen-Witrand et al,21 Lu et al22 and Lemos et al23 studied the efficacy and safety of bDMARDs in treating PsA, and found that the physical summarised component of SF-36 Score was improved, HAQ Score and PASI Score were decreased, but the change of mental summarised component of SF-36 Score was not significant. This indicated that the effects of bDMARDs on QoL in PsA need to be further evaluated.

    The purpose of this study is to conduct a meta-analysis of randomised controlled trials (RCTs) related to bDMARDs in treating PsA, to comprehensively evaluate the effects of bDMARDs on QoL with multiple outcome indicators and to provide evidence for supporting pharmacists and physicians’ clinical actions and decisions in treating PsA. The SF-36, HAQ, NHP and EQ-5D are generic instruments, scores measured by them are the primary outcomes of this study. The scores measured by other disease-specific instruments are the secondary outcomes.

    Materials and methods

    Search strategy and study selection

    This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines.24 To identify RCTs reporting the effects of bDMARDs on QoL, two independent authors (YqL and ZD) electronically conducted the searches in PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure, WanFang Database and VIP Datebase, from inception to November 2020 and updated on 19 February 2022. The keywords used for database searches were: patients, including “psoriatic arthritis”; intervention, including “etanercept” or “infliximab” or “adalimumab” or “golimumab” or “certolizumab” or “ustekinumab” or “guselkumab” or “risankizumab” or “tildrakizumab” or “secukinumab” or “ixekizumab” or “brodalumab” or “tumor necrosis factor inhibitor” or “TNFi” or “interleukin-12/23 inhibitor” or “IL-12/23i” or “interleukin-17 inhibitor” or “IL-17i” or “biologic”; and outcomes, including “health-related quality of life” or “HRQoL” or “Dermatology Life Quality Index” or “DLQI” or “disease activity index for psoriatic arthritis” or “DAPSA” or “psoriasis area and severity index” or “PASI” or “short form-36” or “SF-36” or “health assessment questionnaire” or “HAQ” or “Nottingham Health Profile” or “NHP” or “EuroQol-5D” or “EQ-5D” or “psoriasis disability index” or “PDI” or “Skindex-29” or “Skindex-17” or “PsAQoL” or “quality of life”. To avoid missing any related studies, the authors checked the reference citation sections of eligible articles as an additional level of searching. Research articles were limited to those regarding RCTs that were published in English or Chinese. The complete electronic search strategy for PubMed is provided in online supplemental table S1.

    Inclusion and exclusion criteria

    Studies were independently selected by two authors (YqL and ZD), and they achieved good agreement (κ=0.942). Studies were included if they met the following inclusion criteria: (1) the trial was a human study conducted on patients with PsA; (2) the experimental group was treated with bDMARDs or bDMARDs combined with other non-bDMARDs, while placebo and other non-bDMARDs were used as the control groups; (3) the study provided appropriate data (means and SD of continuous outcomes, the events number of dichotomous outcomes) for each group present at baseline and end of intervention for DLQI, DAPSA, PASI, SF-36, HAQ, NHP, EQ-5D, PDI, Skindex and PsAQoL. Other studies, including animal experiments, in vitro studies, case reports, observational studies, systematic reviews, duplicate publications, study protocols without findings, or congress abstracts without full texts were excluded.

    Data extraction and quality assessment

    Two authors (YqL and ZD) independently extracted data from each selected RCT using a standard abstraction Excel sheet (κ=0.959). The extracted data included trial name, sample size, characteristics of participants, duration of treatment and outcomes of interest. The methodological quality of the selected RCTs was evaluated by two independent investigators (YqL and ZD) using the Cochrane Collaboration risk-of-bias tool (κ=0.853).25 The Cochrane Collaboration risk-of-bias tool used the following criteria for quality assessment: randomisation generation, allocation concealment, blinding of participants and outcome assessment, incomplete outcome data, selective outcome reporting, and other sources of bias. Any disagreement between the reviewing authors was resolved by discussion and final consensus or when a third author (FC) approved the findings.

    Data synthesis and statistical analysis

    All statistical analyses were conducted using Review Manager V.5.3 software (Cochrane Collaboration, Copenhagen, Denmark) and STATA software V.16.0 (Stata Corp, College Station, Texas, USA). The risk ratio (RR) with 95% CI was used to evaluate dichotomous outcomes, and the mean difference (MD) with 95% CI was generated to evaluate continuous outcomes. Heterogeneity was assessed by using the I2 estimate and the p value of the χ2-test. If the p value>0.10 and I2<50%, the assumption of homogeneity was made and the fixed effects model was used for analyses. Otherwise, heterogeneity was assumed, the random effects model was used to analyse and its source should be further determined by sensitivity analysis or subgroup analysis. Sensitivity analyses were conducted using a leave-one-out method to determine the effect of each trial on the reliability of overall pooled effect sizes. Further, subgroup analyses were carried out to determine the source of heterogeneity according to the potential moderator variables. First, the subgroup analyses were conducted according to the experimental groups and control groups (bDMARDs vs placebo, bDMARDs+methotrexate (MTX) vs MTX, bDMARDs vs tofacitinib, bDMARDs vs MTX), which were probably the biggest cause of heterogeneity. Then, each subgroup was analysed according to the following variables: category of bDMARDs (TNFi, IL-12/23i, IL-17i), variety of bDMARDs (etanercept, infliximab, adalimumab, etc), duration of PsA (<6 years, 6–9 years, ≥9 years, unclear), duration of treatment (<24 weeks, ≥24 weeks). The funnel plot, as well as Egger’s test, was used to determine any possible publication bias.

    Results

    Search results

    The detailed step-by-step process of article identification and selection is presented in figure 1. In online searches, 3190 articles were identified initially. After duplicates and irrelevant articles were removed, 47 articles26–72 (37 RCTs reported) were ultimately included in the meta-analysis. There was a total of 14 115 participants in those RCTs. Overall, 25 RCTs have reported the effects of bDMARDs on HAQ Disability Index (HAQ-DI), 23 RCTs on SF-36 physical component summary (PCS), 18 RCTs on SF-36 mental component summary (MCS), 1 RCT on SF-36 Score, 8 RCTs on DLQI, 3 RCTs on EuroQol Visual Analogue Scale (EQ-VAS), 2 RCTs on PsAQoL, 2 RCT on DAPSA, 7 RCTs on the proportion of participants achieving 50% improvement from baseline in PASI (PASI 50), 2 RCTs on PASI 70, 27 RCTs on PASI 75, 26 RCTs on PASI 90, 10 RCTs on PASI 100 and 1 RCT on PASI Score. Among them, HAQ-DI, DLQI, PsAQoL, DAPSA and PASI scores are negative outcomes, and higher scores indicate worse health-related QoL, while the others are the opposite. The detailed characteristics of selected RCTs are summarised in online supplemental table S2. The methodological quality assessment of RCTs based on the Cochrane Collaboration risk-of-bias tool is shown in figure 2. Meta-analysis was not performed for the outcomes reported in less than three RCTs.

    Figure 1
    Figure 1

    Flowchart of the study selection. RCT, randomised controlled trial.

    Figure 2
    Figure 2

    Quality assessment of included randomised controlled trials using Cochrane’s risk-of-bias tool.

    Main outcomes

    Forest plots demonstrating the effects of bDMARDs on QoL are provided in online supplemental figures S1–S9. The pooled effect sizes of all outcomes are summarised in table 1. The results show that bDMARDs taken by patients with PsA can significantly decrease HAQ-DI (MD=−0.19; 95% CI, −0.22 to –0.17; p<0.00001; I2: 100%), DLQI (MD=−4.36; 95% CI, −5.76 to –2.96; p<0.00001; I2: 99%) and improve SF-36 PCS (MD=3.76; 95% CI, 3.42 to 4.10; p<0.00001; I2: 99%), SF-36 MCS (MD=1.76; 95% CI, 1.27 to 2.25; p<0.00001; I2: 99%), EQ-VAS (MD=5.27; 95% CI, 1.21 to 9.34; p<0.00001; I2: 99%), PASI 50 (RR=4.09; 95% CI, 2.71 to 6.16; p<0.00001; I2: 82%), PASI 75 (RR=4.72; 95% CI, 3.87 to 5.75; p<0.00001; I2: 81%), PASI 90 (RR=5.73; 95% CI, 4.73 to 6.95; p<0.00001; I2: 59%), PASI 100 (RR=9.57; 95% CI, 7.38 to 12.43; p<0.00001; I2: 13%). The changes in all outcomes mean that the bDMARDs can effectively improve the QoL of patients with PsA.

    View this table:
    Table 1

    Meta-analysis of RCTs that examined the effects of bDMARDs on QoL

    Figure 3
    Figure 3

    Funnel plots of (A) HAQ-DI, (B) SF-36 PCS, (C) SF-36 MCS, (D) PASI 75, (E) PASI 90 and (F) PASI 100. HAQ-DI, Health Assessment Questionnaire Disability Index; PASI 75/90/100, the proportion of participants achieving 75%/90%/100% improvement from baseline in Psoriasis Area Severity Index; SF-36 MCS, mental component summary of the Short Form 36; SF-36 PCS, physical component summary of the Short Form 36.

    Sensitivity analysis

    With the exclusion of any single study, the heterogeneity did not change materially in terms of any outcomes except PASI 90. After excluding Tao et al27, the heterogeneity of PASI 90 decreased from 59% to 41%. After excluding NCT02181673 (GO-VIBRANT), postsensitivity pooled MD for EQ-VAS was 3.71 (95% CI, −0.58 to 7.99), which differed from presensitivity significantly. No statistically significant difference was found between presensitivity and postsensitivity pooled MDs or RRs for HAQ-DI, SF-36 PCS, SF-36 MCS, DLQI, PASI 50, PASI 75 and PASI 90. The detailed results of sensitivity analyses are presented in table 2.

    View this table:
    Table 2

    Sensitivity analysis of RCTs that examined the effects of bDMARDs on QoL

    Subgroup analysis

    Following subgroup analyses, heterogeneity was changed among some of the strata of subgroups. Regarding the subgroup of bDMARDs versus placebo, there was a significant difference between presubgroup and postsubgroup analysis for HAQ-DI in strata of golimumab (MD=0.08; 95% CI, −0.53 to 0.69), SF-36 MCS in strata of adalimumab (MD=1.24; 95% CI, −0.11 to 2.59) and strata of <24 weeks (MD=−0.13; 95% CI, −0.39 to 0.13), DLQI in strata of adalimumab, ixekizumab, 6–9 years and <24 weeks. Similar results were found for HAQ-DI and SF-36 MCS in the subgroup of bDMARDs+MTX versus MTX, HAQ-DI, SF-36 MCS, EQ-VAS and PASI 75 in the subgroup of bDMARDs versus tofacitinib, SF-36 MCS in the subgroup of bDMARDs versus MTX. In general, bDMARDs had obvious advantages in improving the QoL of PsA compared with placebo, but bDMARDs+MTX compared with MTX, bDMARDs compared with tofacitinib and bDMARDs compared with MTX had no obvious advantages or disadvantages in improving the QoL of PsA. Taking the outcome of HAQ-DI as an example, the results of the subgroups of bDMARDs versus placebo, bDMARDs+MTX versus MTX, bDMARDs versus tofacitinib and bDMARDs versus MTX were −0.21 (MD, 95% CI, −0.23 to –0.18), −0.22 (MD, 95% CI, −0.58 to 0.14), –0.01 (MD, 95% CI, −0.05 to 0.04) and –0.03 (MD, 95% CI, −0.04 to –0.02), respectively. The detailed results of the subgroup analysis are presented in online supplemental table S3.

    Publication bias

    Since the funnel chart requires a certain amount of literature, this part of the study was limited to outcomes that included at least 10 RCTs. As presented in figure 3, there was potential publication bias detected for the outcomes including HAQ-DI, SF-36 PCS, SF-36 MCS, PASI 75, PASI 90 and PASI 100. The p value calculated by Egger’s test based on these outcomes also suggested the presence of publication bias, which can likely be attributed to unpublished studies with negative findings.

    Discussion

    This meta-analysis focused on the effects of bDMARDs on QoL in patients with PsA, involving a total of 29 RCTs and 9720 participants. Through the quantitative analysis of nine outcomes, it was found that bDMARDs could effectively improve the QoL of patients with PsA. By reviewing the studies on minimal clinically important differences related to PsA on PubMed and comparing the minimal results of concerned outcomes, it was found that the decrease of HAQ-DI (MD=−0.19; 95% CI, −0.22 to –0.17) was a probable clinically meaningful effect (<−0.131).73 74 Similar results were found for SF-36 PCS (MD=3.76; 95% CI, 3.42 to 4.10; >2.1),75–78 SF-36 MCS (MD=1.76; 95% CI, 1.27 to 2.25; >1.33),76–78 and DLQI (MD=−4.36; 95% CI, −5.76 to –2.96; <−2.24),79 but not for EQ-VAS (MD=5.27; 95% CI, 1.21 to 9.34, <5.35).80–83

    Since the medicines in experimental and control groups had large differences in the effects on QoL, subgroup analysis was conducted according to the experimental groups and control groups. The results showed that there was obvious dissimilarity in subgroups of bDMARDs compared with placebo, tofacitinib and MTX, concerning HAQ-DI, SF-36 MCS, EQ-VAS and PASI 75. The bDMARDs had a significant effect on improving the QoL compared with placebo, but more experimental data were required to confirm the effects of bDMARDs compared with tofacitinib and MTX.

    Looking specifically at the subgroup of bDMARDs versus placebo, the variety of bDMARDs and duration of treatment were probable sources of heterogeneity. Golimumab, adalimumab and ixekizumab had no significant difference from placebo concerning one or two of HAQ-DI, SF-36 MCS and DLQI, which might be due to the efficacy of these bDMARDs that cannot be reflected on the change of QoL. The bDMARDs had no significant difference from placebo in the subgroup of duration of the treatment <24 weeks, which might indicate that long-term use of bDMARDs can improve the QoL of patients.

    In this meta-analysis, quantitative analysis was not performed on the outcomes that were reported in less than three RCTs, including SF-36 Score, PsAQoL, DAPSA, PASI 70 and PASI Score. According to NCT02376790 (SEAM-PsA),61 62 etanercept or plus MTX could decrease DAPSA and improve SF-36 Score compared with MTX, but without statistical significance. The result of NCT0298069265 showed that tildrakizumab could decrease DAPSA compared with placebo without statistical significance. The results of NCT01087788 (RAPID-PsA)43 44 and NCT01392326 (FUTURE 1)45 46 showed that certolizumab pegol and secukinumab could significantly decrease PsAQoL compared with placebo. As for PASI 70, Tao et al27 found that infliximab+MTX got more significant improvement than MTX, while NCT02065713 (GO-DACT)54 found that golimumab+MTX had no difference from MTX. Additionally, Tao et al27 found that the PASI Score of patients in the infliximab+MTX group was significantly lower than that in the MTX group. Taken together, the quantitative analysis results of the effects of bDMARDs on the QoL of patients with PsA are robust.

    The patients who took bDMARDs showed an improvement in terms of SF-36 PCS, EQ-VAS, PASI 50 and PASI 90, which was consistent with the results of previous studies.21–23 However, our meta-analysis showed an improvement in terms of SF-36 MCS, which was inconsistent with the results reported by Lemos et al.23 This variance could be attributed to the differences in search strategies and inclusion criteria. For example, the study of Lemos et al considered the effects of TNFi rather than bDMARDs.23 The articles included in that study concerned not only RCTs but also observational studies.23 Additionally, the new trials that appeared after August 2013 were included in our study and could not have been reviewed by them. Furthermore, this meta-analysis comprehensively and specifically analysed the effects of bDMARDs on the QoL of patients with PsA, and quantitatively analysed some other outcomes that were not studied before, including HAQ-DI and DLQI. The results of this meta-analysis might be used to support the evidence-based clinical application of bDMARDs.

    However, there were several limitations of this meta-analysis. First, all the included studies were published only in English or Chinese, and the results of Egger’s test indicated the presence of some publication bias. Second, most of the included RCTs were multicentre studies. It was difficult to conduct subgroup analysis based on countries and regions to evaluate the effects of bDMARDs on the QoL of patients from different races and backgrounds. Third, the follow-up period for all included studies did not exceed 24 weeks, so the long-term effects were unable to be assessed. Thus, more studies that include longer follow-up periods of using bDMARDs in the treatment of PsA are required in the future to confirm the long-term effect of bDMARDs on the QoL of patients with PsA.

    Conclusions

    In summary, this meta-analysis demonstrated that the use of bDMARDs by patients with PsA appeared to significantly improve the QoL compared with a placebo. To compare bDMARDs with other therapeutic agents, more extensive studies are still required to confirm the effect of single and combined bDMARDs.

    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

    Ethics statements

    Patient consent for publication

    Acknowledgments

    We appreciate Dr C. Benjamin Naman (Ningbo University—China and University of California, San Diego—USA) for critical reading and linguistic editing of the manuscript.

    References

    1. ↵
      1. Singh JA,
      2. Guyatt G,
      3. Ogdie A, et al
      . Special article: 2018 American College of Rheumatology/National psoriasis Foundation guideline for the treatment of psoriatic arthritis. Arthritis Rheumatol 2019;71:5–32.doi:10.1002/art.40726pmid:http://www.ncbi.nlm.nih.gov/pubmed/30499246
      OpenUrlPubMed
    2. ↵
      1. Mease PJ,
      2. Gladman DD,
      3. Papp KA, et al
      . Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol 2013;69:729–35.doi:10.1016/j.jaad.2013.07.023pmid:http://www.ncbi.nlm.nih.gov/pubmed/23981683
      OpenUrlCrossRefPubMed
    3. ↵
      1. Kavanaugh A,
      2. Helliwell P,
      3. Ritchlin CT
      . Psoriatic arthritis and burden of disease: patient perspectives from the population-based multinational assessment of psoriasis and psoriatic arthritis (MAPP) survey. Rheumatol Ther 2016;3:91–102.doi:10.1007/s40744-016-0029-zpmid:http://www.ncbi.nlm.nih.gov/pubmed/27747516
      OpenUrlPubMed
    4. ↵
      1. Scotti L,
      2. Franchi M,
      3. Marchesoni A, et al
      . Prevalence and incidence of psoriatic arthritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2018;48:28–34.doi:10.1016/j.semarthrit.2018.01.003pmid:http://www.ncbi.nlm.nih.gov/pubmed/29398124
      OpenUrlPubMed
    5. ↵
      1. Giannelli A
      . A review for physician assistants and nurse practitioners on the considerations for diagnosing and treating psoriatic arthritis. Rheumatol Ther 2019;6:5–21.doi:10.1007/s40744-018-0133-3pmid:http://www.ncbi.nlm.nih.gov/pubmed/30570707
      OpenUrlPubMed
    6. ↵
      1. Rosen CF,
      2. Mussani F,
      3. Chandran V, et al
      . Patients with psoriatic arthritis have worse quality of life than those with psoriasis alone. Rheumatology 2012;51:571–6.doi:10.1093/rheumatology/ker365pmid:http://www.ncbi.nlm.nih.gov/pubmed/22157469
      OpenUrlCrossRefPubMedWeb of Science
    7. ↵
      1. Salaffi F,
      2. Carotti M,
      3. Gasparini S, et al
      . The health-related quality of life in rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis: a comparison with a selected sample of healthy people. Health Qual Life Outcomes 2009;7:25.doi:10.1186/1477-7525-7-25pmid:http://www.ncbi.nlm.nih.gov/pubmed/19296831
      OpenUrlCrossRefPubMed
    8. ↵
      1. Mease PJ
      . Assessing the impact of psoriatic arthritis on patient function and quality of life: lessons learned from other rheumatologic conditions. Semin Arthritis Rheum 2009;38:320–35.doi:10.1016/j.semarthrit.2008.01.003pmid:http://www.ncbi.nlm.nih.gov/pubmed/18304610
      OpenUrlCrossRefPubMed
    9. ↵
      1. McKenna SP,
      2. Doward LC,
      3. Whalley D, et al
      . Development of the PsAQoL: a quality of life instrument specific to psoriatic arthritis. Ann Rheum Dis 2004;63:162–9.doi:10.1136/ard.2003.006296pmid:http://www.ncbi.nlm.nih.gov/pubmed/14722205
      OpenUrlAbstract/FREE Full Text
    10. ↵
      1. Xia P,
      2. Lu C,
      3. Wang Y
      . Introduction of quality of life scale for psoriatic arthritis and its international application. Chinese Journal of Rheumatology 2015;19:701–4. (Chinese).
      OpenUrl
    11. ↵
      1. Busija L,
      2. Pausenberger E,
      3. Haines TP, et al
      . Adult measures of general health and health-related quality of life: medical outcomes study short form 36-item (SF-36) and short form 12-Item (SF-12) health surveys, Nottingham health profile (NHP), sickness impact profile (SIP), medical outcomes study short form 6D (SF-6D), health Utilities index mark 3 (HUI3), quality of well-being scale (QWB), and assessment of quality of life (AQoL). Arthritis Care Res 2011;63 Suppl 11:S383–412.doi:10.1002/acr.20541pmid:http://www.ncbi.nlm.nih.gov/pubmed/22588759
      OpenUrlPubMed
    12. ↵
      1. Bruce B,
      2. Fries JF
      . The Stanford health assessment questionnaire: dimensions and practical applications. Health Qual Life Outcomes 2003;1:20.doi:10.1186/1477-7525-1-20pmid:http://www.ncbi.nlm.nih.gov/pubmed/12831398
      OpenUrlCrossRefPubMed
    13. ↵
      1. Balestroni G,
      2. Bertolotti G
      . [EuroQol-5D (EQ-5D): an instrument for measuring quality of life]. Monaldi Arch Chest Dis 2012;78:155–9.doi:10.4081/monaldi.2012.121pmid:http://www.ncbi.nlm.nih.gov/pubmed/23614330
      OpenUrlPubMed
    14. ↵
      1. Mease PJ
      . Measures of psoriatic arthritis: tender and swollen joint assessment, psoriasis area and severity index (PASI), nail psoriasis severity index (NAPSI), modified nail psoriasis severity index (mNAPSI), Mander/Newcastle Enthesitis index (Mei), Leeds Enthesitis index (LEI), spondyloarthritis research Consortium of Canada (SPARCC), Maastricht ankylosing spondylitis Enthesis score (MASES), Leeds Dactylitis index (LDI), patient global for psoriatic arthritis, dermatology life quality index (DLQI), psoriatic arthritis quality of life (PsAQOL), functional assessment of chronic illness Therapy-Fatigue (FACIT-F), psoriatic arthritis response criteria (PsARC), psoriatic arthritis joint activity index (PsAJAI), disease activity in psoriatic arthritis (DAPSA), and composite psoriatic disease activity index (CPDAI). Arthritis Care Res 2011;63 Suppl 11:S64–85.doi:10.1002/acr.20577pmid:http://www.ncbi.nlm.nih.gov/pubmed/22588772
      OpenUrlPubMed
    15. ↵
      1. Lewis VJ,
      2. Finlay AY
      . Two decades experience of the psoriasis disability index. Dermatology 2005;210:261–8.doi:10.1159/000084748pmid:http://www.ncbi.nlm.nih.gov/pubmed/15942210
      OpenUrlCrossRefPubMed
    16. ↵
      1. Prinsen CAC,
      2. Lindeboom R,
      3. Sprangers MAG, et al
      . Health-Related quality of life assessment in dermatology: interpretation of Skindex-29 scores using patient-based anchors. J Invest Dermatol 2010;130:1318–22.doi:10.1038/jid.2009.404pmid:http://www.ncbi.nlm.nih.gov/pubmed/20032989
      OpenUrlPubMed
    17. ↵
      1. Simons N,
      2. Degboé Y,
      3. Barnetche T, et al
      . Biological DMARD efficacy in psoriatic arthritis: a systematic literature review and meta-analysis on articular, enthesitis, dactylitis, skin and functional outcomes. Clin Exp Rheumatol 2020;38:508–15.pmid:http://www.ncbi.nlm.nih.gov/pubmed/31969228
      OpenUrlPubMed
    18. ↵
      1. Cawson MR,
      2. Mitchell SA,
      3. Knight C, et al
      . Systematic review, network meta-analysis and economic evaluation of biological therapy for the management of active psoriatic arthritis. BMC Musculoskelet Disord 2014;15:26.doi:10.1186/1471-2474-15-26pmid:http://www.ncbi.nlm.nih.gov/pubmed/24444034
      OpenUrlPubMed
    19. ↵
      1. Gossec L,
      2. Baraliakos X,
      3. Kerschbaumer A, et al
      . EULAR recommendations for the management of psoriatic arthritis with pharmacological therapies: 2019 update. Ann Rheum Dis 2020;79:700–12.doi:10.1136/annrheumdis-2020-217159pmid:http://www.ncbi.nlm.nih.gov/pubmed/32434812
      OpenUrlAbstract/FREE Full Text
    20. ↵
      1. Kamata M,
      2. Tada Y
      . Efficacy and safety of biologics for psoriasis and psoriatic arthritis and their impact on comorbidities: a literature review. Int J Mol Sci 2020;21:1690.doi:10.3390/ijms21051690pmid:http://www.ncbi.nlm.nih.gov/pubmed/32121574
      OpenUrlPubMed
    21. ↵
      1. Ruyssen-Witrand A,
      2. Perry R,
      3. Watkins C, et al
      . Efficacy and safety of biologics in psoriatic arthritis: a systematic literature review and network meta-analysis. RMD Open 2020;6:e001117.doi:10.1136/rmdopen-2019-001117pmid:http://www.ncbi.nlm.nih.gov/pubmed/32094304
      OpenUrlAbstract/FREE Full Text
    22. ↵
      1. Lu C,
      2. Wallace BI,
      3. Waljee AK, et al
      . Comparative efficacy and safety of targeted DMARDs for active psoriatic arthritis during induction therapy: a systematic review and network meta-analysis. Semin Arthritis Rheum 2019;49:381–8.doi:10.1016/j.semarthrit.2019.06.001pmid:http://www.ncbi.nlm.nih.gov/pubmed/31272807
      OpenUrlPubMed
    23. ↵
      1. Lemos LLP,
      2. de Oliveira Costa J,
      3. Almeida AM, et al
      . Treatment of psoriatic arthritis with anti-TNF agents: a systematic review and meta-analysis of efficacy, effectiveness and safety. Rheumatol Int 2014;34:1345–60.doi:10.1007/s00296-014-3006-2pmid:http://www.ncbi.nlm.nih.gov/pubmed/24728068
      OpenUrlCrossRefPubMed
    24. ↵
      1. Page MJ,
      2. McKenzie JE,
      3. Bossuyt PM, et al
      . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71.doi:10.1136/bmj.n71pmid:http://www.ncbi.nlm.nih.gov/pubmed/33782057
      OpenUrlFREE Full Text
    25. ↵
      1. Higgins JPT,
      2. Thomas J,
      3. Chandler J
      . Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021). Cochrane, 2021. Available: www.training.cochrane.org/handbook
    26. ↵
      1. Genovese MC,
      2. Mease PJ,
      3. Thomson GTD, et al
      . Safety and efficacy of adalimumab in treatment of patients with psoriatic arthritis who had failed disease modifying antirheumatic drug therapy. J Rheumatol 2007;34:1040–50.pmid:http://www.ncbi.nlm.nih.gov/pubmed/17444593
      OpenUrlAbstract/FREE Full Text
    27. ↵
      1. Tao H,
      2. Zheng J,
      3. Ye Q
      . Effect of infliximab combined with methotrexate on serum alkaline phosphatase levels in patients with psoriatic arthritis and its curative effect. Chinese Journal of Immunology 2019;35:98–101. (Chinese).
      OpenUrl
    28. ↵
      1. Antoni CE,
      2. Kavanaugh A,
      3. Kirkham B, et al
      . Sustained benefits of infliximab therapy for dermatologic and articular manifestations of psoriatic arthritis: results from the infliximab multinational psoriatic arthritis controlled trial (impact). Arthritis Rheum 2005;52:1227–36.doi:10.1002/art.20967pmid:http://www.ncbi.nlm.nih.gov/pubmed/15818699
      OpenUrlCrossRefPubMedWeb of Science
    29. ↵
      1. Mease PJ,
      2. Goffe BS,
      3. Metz J, et al
      . Etanercept in the treatment of psoriatic arthritis and psoriasis: a randomised trial. Lancet 2000;356:385–90.doi:10.1016/S0140-6736(00)02530-7pmid:http://www.ncbi.nlm.nih.gov/pubmed/10972371
      OpenUrlCrossRefPubMedWeb of Science
    30. ↵
      1. Kavanaugh A,
      2. Krueger GG,
      3. Beutler A, et al
      . Infliximab maintains a high degree of clinical response in patients with active psoriatic arthritis through 1 year of treatment: results from the impact 2 trial. Ann Rheum Dis 2007;66:498–505.doi:10.1136/ard.2006.058339pmid:http://www.ncbi.nlm.nih.gov/pubmed/17114188
      OpenUrlAbstract/FREE Full Text
    31. ↵
      1. Kavanaugh A,
      2. Antoni C,
      3. Krueger GG, et al
      . Infliximab improves health related quality of life and physical function in patients with psoriatic arthritis. Ann Rheum Dis 2006;65:471–7.doi:10.1136/ard.2005.040196pmid:http://www.ncbi.nlm.nih.gov/pubmed/16096330
      OpenUrlAbstract/FREE Full Text
    32. ↵
      1. Antoni C,
      2. Krueger GG,
      3. de Vlam K, et al
      . Infliximab improves signs and symptoms of psoriatic arthritis: results of the impact 2 trial. Ann Rheum Dis 2005;64:1150–7.doi:10.1136/ard.2004.032268pmid:http://www.ncbi.nlm.nih.gov/pubmed/15677701
      OpenUrlAbstract/FREE Full Text
    33. ↵
      1. Mease PJ,
      2. Gladman DD,
      3. Ritchlin CT, et al
      . Adalimumab for the treatment of patients with moderately to severely active psoriatic arthritis: results of a double-blind, randomized, placebo-controlled trial. Arthritis Rheum 2005;52:3279–89.doi:10.1002/art.21306pmid:http://www.ncbi.nlm.nih.gov/pubmed/16200601
      OpenUrlCrossRefPubMedWeb of Science
    34. ↵
      1. Gladman DD,
      2. Mease PJ,
      3. Cifaldi MA, et al
      . Adalimumab improves joint-related and skin-related functional impairment in patients with psoriatic arthritis: patient-reported outcomes of the adalimumab effectiveness in psoriatic arthritis trial. Ann Rheum Dis 2007;66:163–8.doi:10.1136/ard.2006.057901pmid:http://www.ncbi.nlm.nih.gov/pubmed/17046964
      OpenUrlAbstract/FREE Full Text
    35. ↵
      1. Gladman DD,
      2. Mease PJ,
      3. Ritchlin CT, et al
      . Adalimumab for long-term treatment of psoriatic arthritis: forty-eight week data from the adalimumab effectiveness in psoriatic arthritis trial. Arthritis Rheum 2007;56:476–88.doi:10.1002/art.22379pmid:http://www.ncbi.nlm.nih.gov/pubmed/17265483
      OpenUrlCrossRefPubMedWeb of Science
    36. ↵
      1. Kavanaugh A,
      2. McInnes I,
      3. Mease P, et al
      . Golimumab, a new human tumor necrosis factor alpha antibody, administered every four weeks as a subcutaneous injection in psoriatic arthritis: Twenty-four-week efficacy and safety results of a randomized, placebo-controlled study. Arthritis Rheum 2009;60:976–86.doi:10.1002/art.24403pmid:http://www.ncbi.nlm.nih.gov/pubmed/19333944
      OpenUrlCrossRefPubMedWeb of Science
    37. ↵
      1. Kavanaugh A,
      2. McInnes IB,
      3. Krueger GG, et al
      . Patient-Reported outcomes and the association with clinical response in patients with active psoriatic arthritis treated with golimumab: findings through 2 years of a phase III, multicenter, randomized, double-blind, placebo-controlled trial. Arthritis Care Res 2013;65:1666–73.doi:10.1002/acr.22044pmid:http://www.ncbi.nlm.nih.gov/pubmed/23666608
      OpenUrlPubMedWeb of Science
    38. ↵
      1. Mease PJ,
      2. Kivitz AJ,
      3. Burch FX, et al
      . Etanercept treatment of psoriatic arthritis: safety, efficacy, and effect on disease progression. Arthritis Rheum 2004;50:2264–72.doi:10.1002/art.20335pmid:http://www.ncbi.nlm.nih.gov/pubmed/15248226
      OpenUrlCrossRefPubMedWeb of Science
    39. ↵
      1. Baranauskaite A,
      2. Raffayová H,
      3. Kungurov NV, et al
      . Infliximab plus methotrexate is superior to methotrexate alone in the treatment of psoriatic arthritis in methotrexate-naive patients: the respond study. Ann Rheum Dis 2012;71:541–8.doi:10.1136/ard.2011.152223pmid:http://www.ncbi.nlm.nih.gov/pubmed/21994233
      OpenUrlAbstract/FREE Full Text
    40. ↵
      1. McInnes IB,
      2. Sieper J,
      3. Braun J, et al
      . Efficacy and safety of secukinumab, a fully human anti-interleukin-17A monoclonal antibody, in patients with moderate-to-severe psoriatic arthritis: a 24-week, randomised, double-blind, placebo-controlled, phase II proof-of-concept trial. Ann Rheum Dis 2014;73:349–56.doi:10.1136/annrheumdis-2012-202646pmid:http://www.ncbi.nlm.nih.gov/pubmed/23361084
      OpenUrlAbstract/FREE Full Text
    41. ↵
      1. McInnes IB,
      2. Kavanaugh A,
      3. Gottlieb AB, et al
      . Efficacy and safety of ustekinumab in patients with active psoriatic arthritis: 1 year results of the phase 3, multicentre, double-blind, placebo-controlled PSUMMIT 1 trial. Lancet 2013;382:780–9.doi:10.1016/S0140-6736(13)60594-2pmid:http://www.ncbi.nlm.nih.gov/pubmed/23769296
      OpenUrlCrossRefPubMedWeb of Science
    42. ↵
      1. Ritchlin C,
      2. Rahman P,
      3. Kavanaugh A, et al
      . Efficacy and safety of the anti-IL-12/23 p40 monoclonal antibody, ustekinumab, in patients with active psoriatic arthritis despite conventional non-biological and biological anti-tumour necrosis factor therapy: 6-month and 1-year results of the phase 3, multicentre, double-blind, placebo-controlled, randomised PSUMMIT 2 trial. Ann Rheum Dis 2014;73:990–9.doi:10.1136/annrheumdis-2013-204655pmid:http://www.ncbi.nlm.nih.gov/pubmed/24482301
      OpenUrlAbstract/FREE Full Text
    43. ↵
      1. Gladman D,
      2. Fleischmann R,
      3. Coteur G, et al
      . Effect of certolizumab pegol on multiple facets of psoriatic arthritis as reported by patients: 24-week patient-reported outcome results of a phase III, multicenter study. Arthritis Care Res 2014;66:1085–92.doi:10.1002/acr.22256pmid:http://www.ncbi.nlm.nih.gov/pubmed/24339179
      OpenUrlCrossRefPubMed
    44. ↵
      1. Mease PJ,
      2. Fleischmann R,
      3. Deodhar AA, et al
      . Effect of certolizumab pegol on signs and symptoms in patients with psoriatic arthritis: 24-week results of a phase 3 double-blind randomised placebo-controlled study (RAPID-PsA). Ann Rheum Dis 2014;73:48–55.doi:10.1136/annrheumdis-2013-203696pmid:http://www.ncbi.nlm.nih.gov/pubmed/23942868
      OpenUrlAbstract/FREE Full Text
    45. ↵
      1. Mease PJ,
      2. McInnes IB,
      3. Kirkham B, et al
      . Secukinumab inhibition of interleukin-17A in patients with psoriatic arthritis. N Engl J Med 2015;373:1329–39.doi:10.1056/NEJMoa1412679pmid:http://www.ncbi.nlm.nih.gov/pubmed/26422723
      OpenUrlCrossRefPubMed
    46. ↵
      1. Strand V,
      2. Mease P,
      3. Gossec L, et al
      . Secukinumab improves patient-reported outcomes in subjects with active psoriatic arthritis: results from a randomised phase III trial (future 1). Ann Rheum Dis 2017;76:203–7.doi:10.1136/annrheumdis-2015-209055pmid:http://www.ncbi.nlm.nih.gov/pubmed/27169431
      OpenUrlAbstract/FREE Full Text
    47. ↵
      1. Mease PJ,
      2. van der Heijde D,
      3. Ritchlin CT, et al
      . Ixekizumab, an interleukin-17A specific monoclonal antibody, for the treatment of biologic-naive patients with active psoriatic arthritis: results from the 24-week randomised, double-blind, placebo-controlled and active (adalimumab)-controlled period of the phase III trial SPIRIT-P1. Ann Rheum Dis 2017;76:79–87.doi:10.1136/annrheumdis-2016-209709pmid:http://www.ncbi.nlm.nih.gov/pubmed/27553214
      OpenUrlAbstract/FREE Full Text
    48. ↵
      1. Gottlieb AB,
      2. Strand V,
      3. Kishimoto M, et al
      . Ixekizumab improves patient-reported outcomes up to 52 weeks in bDMARD-naïve patients with active psoriatic arthritis (SPIRIT-P1). Rheumatology 2018;57:1777–88.doi:10.1093/rheumatology/key161pmid:http://www.ncbi.nlm.nih.gov/pubmed/29945203
      OpenUrlCrossRefPubMed
    49. ↵
      1. McInnes IB,
      2. Mease PJ,
      3. Kirkham B, et al
      . Secukinumab, a human anti-interleukin-17A monoclonal antibody, in patients with psoriatic arthritis (future 2): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2015;386:1137–46.doi:10.1016/S0140-6736(15)61134-5pmid:http://www.ncbi.nlm.nih.gov/pubmed/26135703
      OpenUrlCrossRefPubMed
    50. ↵
      1. Mease P,
      2. Hall S,
      3. FitzGerald O, et al
      . Tofacitinib or adalimumab versus placebo for psoriatic arthritis. N Engl J Med 2017;377:1537–50.doi:10.1056/NEJMoa1615975pmid:http://www.ncbi.nlm.nih.gov/pubmed/29045212
      OpenUrlCrossRefPubMed
    51. ↵
      1. Strand V,
      2. de Vlam K,
      3. Covarrubias-Cobos JA, et al
      . Tofacitinib or adalimumab versus placebo: patient-reported outcomes from opal Broaden-a phase III study of active psoriatic arthritis in patients with an inadequate response to conventional synthetic disease-modifying antirheumatic drugs. RMD Open 2019;5:e000806.doi:10.1136/rmdopen-2018-000806pmid:http://www.ncbi.nlm.nih.gov/pubmed/30713721
      OpenUrlPubMed
    52. ↵
      1. Nash P,
      2. Mease PJ,
      3. McInnes IB, et al
      . Efficacy and safety of secukinumab administration by autoinjector in patients with psoriatic arthritis: results from a randomized, placebo-controlled trial (future 3). Arthritis Res Ther 2018;20:47.doi:10.1186/s13075-018-1551-xpmid:http://www.ncbi.nlm.nih.gov/pubmed/29544534
      OpenUrlPubMed
    53. ↵
      1. Mease PJ,
      2. Helliwell PS,
      3. Hjuler KF, et al
      . Brodalumab in psoriatic arthritis: results from the randomised phase III AMVISION-1 and AMVISION-2 trials. Ann Rheum Dis 2021;80:185–93.doi:10.1136/annrheumdis-2019-216835pmid:http://www.ncbi.nlm.nih.gov/pubmed/33106286
      OpenUrlAbstract/FREE Full Text
    54. ↵
      1. Vieira-Sousa E,
      2. Alves P,
      3. Rodrigues AM, et al
      . GO-DACT: a phase 3B randomised, double-blind, placebo-controlled trial of golimumab plus methotrexate (MTX) versus placebo plus MTX in improving DACTylitis in MTX-naive patients with psoriatic arthritis. Ann Rheum Dis 2020;79:490–8.doi:10.1136/annrheumdis-2019-216500pmid:http://www.ncbi.nlm.nih.gov/pubmed/32193187
      OpenUrlAbstract/FREE Full Text
    55. ↵
      1. Kavanaugh A,
      2. Husni ME,
      3. Harrison DD, et al
      . Safety and efficacy of intravenous golimumab in patients with active psoriatic arthritis: results through week twenty-four of the GO-VIBRANT study. Arthritis Rheumatol 2017;69:2151–61.doi:10.1002/art.40226pmid:http://www.ncbi.nlm.nih.gov/pubmed/28805045
      OpenUrlPubMed
    56. ↵
      1. Husni ME,
      2. Kavanaugh A,
      3. Chan EKH, et al
      . Effects of intravenous golimumab on health-related quality of life in patients with psoriatic arthritis: 24-week results of the GO-VIBRANT trial. Value Health 2020;23:1286–91.doi:10.1016/j.jval.2020.06.007pmid:http://www.ncbi.nlm.nih.gov/pubmed/33032771
      OpenUrlPubMed
    57. ↵
      1. Kivitz AJ,
      2. Nash P,
      3. Tahir H, et al
      . Efficacy and Safety of Subcutaneous Secukinumab 150 mg with or Without Loading Regimen in Psoriatic Arthritis: Results from the FUTURE 4 Study. Rheumatol Ther 2019;6:393–407.doi:10.1007/s40744-019-0163-5pmid:http://www.ncbi.nlm.nih.gov/pubmed/31228101
      OpenUrlPubMed
    58. ↵
      1. Deodhar A,
      2. Gottlieb AB,
      3. Boehncke W-H, et al
      . Efficacy and safety of guselkumab in patients with active psoriatic arthritis: a randomised, double-blind, placebo-controlled, phase 2 study. Lancet 2018;391:2213–24.doi:10.1016/S0140-6736(18)30952-8pmid:http://www.ncbi.nlm.nih.gov/pubmed/29893222
      OpenUrlCrossRefPubMed
    59. ↵
      1. Nash P,
      2. Kirkham B,
      3. Okada M, et al
      . Ixekizumab for the treatment of patients with active psoriatic arthritis and an inadequate response to tumour necrosis factor inhibitors: results from the 24-week randomised, double-blind, placebo-controlled period of the SPIRIT-P2 phase 3 trial. Lancet 2017;389:2317–27.doi:10.1016/S0140-6736(17)31429-0pmid:http://www.ncbi.nlm.nih.gov/pubmed/28551073
      OpenUrlCrossRefPubMed
    60. ↵
      1. Mease PJ,
      2. Genovese MC,
      3. Weinblatt ME, et al
      . Phase II study of ABT-122, a tumor necrosis factor- and Interleukin-17A-Targeted dual variable domain immunoglobulin, in patients with psoriatic arthritis with an inadequate response to methotrexate. Arthritis Rheumatol 2018;70:1778–89.doi:10.1002/art.40579pmid:http://www.ncbi.nlm.nih.gov/pubmed/29855175
      OpenUrlPubMed
    61. ↵
      1. Mease PJ,
      2. Gladman DD,
      3. Collier DH, et al
      . Etanercept and methotrexate as monotherapy or in combination for psoriatic arthritis: primary results from a randomized, controlled phase III trial. Arthritis Rheumatol 2019;71:1112–24.doi:10.1002/art.40851pmid:http://www.ncbi.nlm.nih.gov/pubmed/30747501
      OpenUrlPubMed
    62. ↵
      1. Coates LC,
      2. Merola JF,
      3. Mease PJ, et al
      . Performance of composite measures used in a trial of etanercept and methotrexate as monotherapy or in combination in psoriatic arthritis. Rheumatology 2021;60:1137–47.doi:10.1093/rheumatology/keaa271pmid:http://www.ncbi.nlm.nih.gov/pubmed/32864685
      OpenUrlPubMed
    63. ↵
      1. Mease P,
      2. van der Heijde D,
      3. Landewé R, et al
      . Secukinumab improves active psoriatic arthritis symptoms and inhibits radiographic progression: primary results from the randomised, double-blind, phase III future 5 study. Ann Rheum Dis 2018;77:890–7.doi:10.1136/annrheumdis-2017-212687pmid:http://www.ncbi.nlm.nih.gov/pubmed/29550766
      OpenUrlAbstract/FREE Full Text
    64. ↵
      1. Baraliakos X,
      2. Gossec L,
      3. Pournara E, et al
      . Secukinumab in patients with psoriatic arthritis and axial manifestations: results from the double-blind, randomised, phase 3 maximise trial. Ann Rheum Dis 2021;80:582–90.doi:10.1136/annrheumdis-2020-218808pmid:http://www.ncbi.nlm.nih.gov/pubmed/33334727
      OpenUrlAbstract/FREE Full Text
    65. ↵
      1. Mease PJ,
      2. Chohan S,
      3. Fructuoso FJG, et al
      . Efficacy and safety of tildrakizumab in patients with active psoriatic arthritis: results of a randomised, double-blind, placebo-controlled, multiple-dose, 52-week phase IIb study. Ann Rheum Dis 2021;80:1147–57.doi:10.1136/annrheumdis-2020-219014pmid:http://www.ncbi.nlm.nih.gov/pubmed/33985942
      OpenUrlAbstract/FREE Full Text
    66. ↵
      1. Strand V,
      2. Mease PJ,
      3. Soriano ER, et al
      . Improvement in patient-reported outcomes in patients with psoriatic arthritis treated with Upadacitinib versus placebo or adalimumab: results from SELECT-PsA 1. Rheumatol Ther 2021;8:1789–808.doi:10.1007/s40744-021-00379-9pmid:http://www.ncbi.nlm.nih.gov/pubmed/34636026
      OpenUrlPubMed
    67. ↵
      1. Mease PJ,
      2. Rahman P,
      3. Gottlieb AB, et al
      . Guselkumab in biologic-naive patients with active psoriatic arthritis (DISCOVER-2): a double-blind, randomised, placebo-controlled phase 3 trial. Lancet 2020;395:1126–36.doi:10.1016/S0140-6736(20)30263-4pmid:http://www.ncbi.nlm.nih.gov/pubmed/32178766
      OpenUrlCrossRefPubMed
    68. ↵
      1. Deodhar A,
      2. Helliwell PS,
      3. Boehncke W-H, et al
      . Guselkumab in patients with active psoriatic arthritis who were biologic-naive or had previously received TNFα inhibitor treatment (DISCOVER-1): a double-blind, randomised, placebo-controlled phase 3 trial. Lancet 2020;395:1115–25.doi:10.1016/S0140-6736(20)30265-8pmid:http://www.ncbi.nlm.nih.gov/pubmed/32178765
      OpenUrlCrossRefPubMed
    69. ↵
      1. Östör A,
      2. Van den Bosch F,
      3. Papp K, et al
      . Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 2 trial. Ann Rheum Dis 2022;81:351–8.doi:10.1136/annrheumdis-2021-221048pmid:http://www.ncbi.nlm.nih.gov/pubmed/34815219
      OpenUrlAbstract/FREE Full Text
    70. ↵
      1. Kristensen LE,
      2. Keiserman M,
      3. Papp K, et al
      . Efficacy and safety of risankizumab for active psoriatic arthritis: 24-week results from the randomised, double-blind, phase 3 KEEPsAKE 1 trial. Ann Rheum Dis 2022;81:225–31.doi:10.1136/annrheumdis-2021-221019pmid:http://www.ncbi.nlm.nih.gov/pubmed/34911706
      OpenUrlAbstract/FREE Full Text
    71. ↵
      1. Coates LC,
      2. Gossec L,
      3. Theander E, et al
      . Efficacy and safety of guselkumab in patients with active psoriatic arthritis who are inadequate responders to tumour necrosis factor inhibitors: results through one year of a phase IIIB, randomised, controlled study (Cosmos). Ann Rheum Dis 2022;81:359–69.doi:10.1136/annrheumdis-2021-220991pmid:http://www.ncbi.nlm.nih.gov/pubmed/34819273
      OpenUrlAbstract/FREE Full Text
    72. ↵
      1. Lin Y
      . Clinical efficacy of infliximab combined with methotrexate in the treatment of psoriatic arthritis. Heilongjiang Medicine and Pharmacy 2016;39:113–4. (Chinese).
      OpenUrl
    73. ↵
      1. Mease PJ,
      2. Woolley JM,
      3. Bitman B, et al
      . Minimally important difference of health assessment questionnaire in psoriatic arthritis: relating thresholds of improvement in functional ability to patient-rated importance and satisfaction. J Rheumatol 2011;38:2461–5.doi:10.3899/jrheum.110546pmid:http://www.ncbi.nlm.nih.gov/pubmed/21885498
      OpenUrlAbstract/FREE Full Text
    74. ↵
      1. Kwok T,
      2. Pope JE
      . Minimally important difference for patient-reported outcomes in psoriatic arthritis: health assessment questionnaire and pain, fatigue, and global visual analog scales. J Rheumatol 2010;37:1024–8.doi:10.3899/jrheum.090832pmid:http://www.ncbi.nlm.nih.gov/pubmed/20231193
      OpenUrlAbstract/FREE Full Text
    75. ↵
      1. Carreon LY,
      2. Glassman SD,
      3. Campbell MJ, et al
      . Neck disability index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J 2010;10:469–74.doi:10.1016/j.spinee.2010.02.007pmid:http://www.ncbi.nlm.nih.gov/pubmed/20359958
      OpenUrlCrossRefPubMed
    76. ↵
      1. Sekhon S,
      2. Pope J, et al., Canadian Scleroderma Research Group
      . The minimally important difference in clinical practice for patient-centered outcomes including health assessment questionnaire, fatigue, pain, sleep, global visual analog scale, and SF-36 in scleroderma. J Rheumatol 2010;37:591–8.doi:10.3899/jrheum.090375pmid:http://www.ncbi.nlm.nih.gov/pubmed/20080913
      OpenUrlAbstract/FREE Full Text
    77. ↵
      1. Witt S,
      2. Krauss E,
      3. Barbero MAN, et al
      . Psychometric properties and minimal important differences of SF-36 in idiopathic pulmonary fibrosis. Respir Res 2019;20:47.doi:10.1186/s12931-019-1010-5pmid:http://www.ncbi.nlm.nih.gov/pubmed/30823880
      OpenUrlPubMed
    78. ↵
      1. Colangelo KJ,
      2. Pope JE,
      3. Peschken C
      . The minimally important difference for patient reported outcomes in systemic lupus erythematosus including the HAQ-DI, pain, fatigue, and SF-36. J Rheumatol 2009;36:2231–7.doi:10.3899/jrheum.090193pmid:http://www.ncbi.nlm.nih.gov/pubmed/19723907
      OpenUrlAbstract/FREE Full Text
    79. ↵
      1. Basra MKA,
      2. Salek MS,
      3. Camilleri L, et al
      . Determining the minimal clinically important difference and responsiveness of the dermatology life quality index (DLQI): further data. Dermatology 2015;230:27–33.doi:10.1159/000365390pmid:http://www.ncbi.nlm.nih.gov/pubmed/25613671
      OpenUrlPubMed
    80. ↵
      1. Hu X,
      2. Jing M,
      3. Zhang M, et al
      . Responsiveness and minimal clinically important difference of the EQ-5D-5L in cervical intraepithelial neoplasia: a longitudinal study. Health Qual Life Outcomes 2020;18:324.doi:10.1186/s12955-020-01578-8pmid:http://www.ncbi.nlm.nih.gov/pubmed/33008423
      OpenUrlPubMed
    81. ↵
      1. Chen P,
      2. Lin K-C,
      3. Liing R-J, et al
      . Validity, responsiveness, and minimal clinically important difference of EQ-5D-5L in stroke patients undergoing rehabilitation. Qual Life Res 2016;25:1585–96.doi:10.1007/s11136-015-1196-zpmid:http://www.ncbi.nlm.nih.gov/pubmed/26714699
      OpenUrlPubMed
    82. ↵
      1. Zanini A,
      2. Aiello M,
      3. Adamo D, et al
      . Estimation of minimal clinically important difference in EQ-5D visual analog scale score after pulmonary rehabilitation in subjects with COPD. Respir Care 2015;60:88–95.doi:10.4187/respcare.03272pmid:http://www.ncbi.nlm.nih.gov/pubmed/25336531
      OpenUrlAbstract/FREE Full Text
    83. ↵
      1. Nolan CM,
      2. Longworth L,
      3. Lord J, et al
      . The EQ-5D-5L health status questionnaire in COPD: validity, responsiveness and minimum important difference. Thorax 2016;71:493–500.doi:10.1136/thoraxjnl-2015-207782pmid:http://www.ncbi.nlm.nih.gov/pubmed/27030578
      OpenUrlAbstract/FREE Full Text

    Supplementary materials

    • Supplementary Data

      This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Footnotes

    • Contributors YqL substantially contributed to the conception and design of the research, and the acquisition, analysis and interpretation of data; was involved in drafting the manuscript and revising it critically for important intellectual content. ZD substantially contributed to the acquisition, analysis and interpretation of data; was involved in drafting the manuscript and revising it critically for important intellectual content. YL substantially contributed to the conception and design of the research; was involved in revising the manuscript critically for important intellectual content. FC, the guarantor of the manuscript, substantially contributed to the conception and design of the research, and the acquisition, analysis and interpretation of data; involved in revising the manuscript critically for important intellectual content. All authors gave their approval for the manuscript to be submitted in BMJ Open and agreed to be accountable for all aspects of the work.

    • Funding This work was supported by the National Natural Science Foundation of China (Grant no. 71673298).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.