Composite and pragmatic measures in psoriatic arthritis: bridging trials and clinical feasibility

Journal article : Review

Purpose of review
Psoriatic arthritis (PsA) is a multidomain inflammatory disease where no instrument captures the full spectrum of activity or its impact on patients’ lives. Accurate outcome measurement is essential for research and personalised care. This review summarises advances in PsA outcome-measure refinement and harmonisation, with emphasis on psychometric validation, clinical feasibility, and treat-to-target (T2T) strategies.
Recent findings
Multidomain composites such as the Psoriatic Arthritis Disease Activity Score (PASDAS) remain the most comprehensive OMERACT measures, but their complexity limits clinical use. DAPSA and MDA are practical but limited: DAPSA evaluates fewer domains, while MDA’s binary format can miss meaningful partial improvements. The Psoriatic Arthritis Impact of Disease-12 (PsAID-12) has undergone renewed validation with context-specific thresholds, reinforcing its value for assessing the lived burden of disease. Low-DAPSA/high-PsAID-12 discordance underscores the need for layered approaches integrating objective and patient-reported data. Although pragmatic 3VAS/4VAS tools have been proposed to enhance feasibility, recent OMERACT/GRAPPA syntheses show that no PsA randomised clinical trial (RCT) has yet used them, reflecting their very recent introduction. Digital PRO capture and wearable monitoring are emerging to improve real-world feasibility.
Summary
A layered framework—rapid screening with DAPSA, target verification via MDA, deep evaluation using PASDAS or SF-36, and patient-anchored monitoring with PsAID-12—allows multidimensional assessment within minutes. Future directions emphasise outcome personalisation, integrating biomarkers, imaging, and PROs into adaptive algorithms that support shared decision-making. Ultimately, outcome measures should evolve from static scores into dynamic tools that guide both clinical trials and everyday PsA care.

Authors: Kang, J-H; Coates, LC

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Current Opinion in Immunology
• Volume: 99
• Article number: 102746
• Publication date: 2026-02-27
• Acceptance date: 2026-02-05
• DOI: 10.1016/j.coi.2026.102746
• EISSN: 1879-0372
• ISSN: 0952-7915
• Language: English
• Keywords: psoriatic arthritis; OMERACT; DAPSA; PASDAS; PsAID-12; outcome measures
• Subtype: Review