Residual disease associated with suboptimal treatment response in patients with psoriatic arthritis: a systematic review of real world evidence

Objective: This systematic literature review aimed to identify and summarise real-world observational studies reporting the type, prevalence and/or severity of residual symptoms and disease in adults with psoriatic arthritis (PsA) who have received treatment and been assessed against remission or low disease activity targets. Methods: Patients had received treatment and been assessed with treat-to-target metrics including minimal disease activity (MDA), Disease Activity Index in PsA (DAPSA) and others. MEDLINE, Embase® and the Cochrane Database of Systematic Reviews (CDSR) were searched using search terms for PsA, treatment targets and observational studies. Screening of search results was completed by two independent reviewers; studies were included if they reported relevant residual disease outcomes in adults with PsA who had received one or more pharmacological treatments for PsA in a real-world setting. Non-observational studies were excluded. Information from included studies was extracted into a prespecified grid by a single reviewer and checked by a second reviewer. Results: Database searching yielded 2,328 articles; 42 publications (27 unique studies) were included. 23 studies reported outcomes for MDA assessed patients, 14 studies reported outcomes for DAPSA assessed patients. Physician- and patient reported residual disease was less frequent and/or severe in patients reaching targets, but often not absent, including when patients achieved very low disease activity (VLDA) or remission. For example, studies reported 0–8% patients in DAPSA (or clinical DAPSA) remission had >1 tender joint, 25–39% had PASI >1, and 0–10% had patient reported pain >15. Residual disease was usually less frequent and/or severe among patients achieving MDA-assessed targets versus DAPSA­assessed targets, especially for skin outcomes. Conclusion: The findings demonstrate a need for further optimisation of care for patients with PsA.</p

Correction: Association between Psoriasis Vulgaris and Coronary Heart Disease in a Hospital-Based Population in Japan.

[This corrects the article DOI: 10.1371/journal.pone.0149316.]

A qualitative and quantitative analysis of the characteristics of gout patient education resources

Patient education is an important aspect of gout management, but there is evidence that many patients lack adequate knowledge of their condition. Our aim was to examine the characteristics of gout patient education resources. Ten gout patient information resources were examined for readability (Flesch-Kincaid reading level, the Simple Measure of Gobbledygook measure and the Flesch Reading Ease Score), qualitative characteristics such as figure and jargon use and whether they included information on the major points of gout. The median readability grade level of the examined resources was 8.5. The difference in readability grade level between the highest and the lowest education resource was 6.3 grade levels. The information content of the resources was high with an average of only 3.9 proposed criteria of 19 (19 %) absent from the resources. Jargon use was low and concepts were usually explained. However, important information regarding acute flare prophylaxis during urate-lowering therapy initiation and titration and treating serum uric acid to target was absent from 60 % of the patient education resources. There was poor use of key messages at the start. Gout patient resources have a wide range of readability. Thirty percent of resources were above the average reading level of rheumatology outpatients reported in previous studies. Sixty percent of gout patient resources omit education items that could impact on patient adherence and in turn patient outcomes. Further research is needed into the literacy levels and education requirements of patients with gout