@article {Lucassone002031, author = {Florian Lucasson and Uta Kiltz and Umut Kalyoncu and Ying Ying Leung and Pen{\'e}lope Palominos and Juan D Ca{\~n}ete and Rossana Scrivo and Andra Balanescu and Emanuelle Dernis and Sandra Meisalu and Adeline Ryussen-Witrand and Martin Soubrier and Sibel Zehra Aydin and Lihi Eder and Inna Gaydukova and Ennio Lubrano and Pascal Richette and Elaine Husni and Laura C Coates and Maarten de Wit and Josef S Smolen and Ana-Maria Orbai and Laure Gossec}, title = {Disparities in healthcare in psoriatic arthritis: an analysis of 439 patients from 13 countries}, volume = {8}, number = {1}, elocation-id = {e002031}, year = {2022}, doi = {10.1136/rmdopen-2021-002031}, publisher = {BMJ Specialist Journals}, abstract = {Objectives Patient care can vary substantially by country. The objective was to explore differences in psoriatic arthritis (PsA) across countries for disease activity, impact and treatments.Methods A cross-sectional analysis of 13 countries from the Remission/Flare in PsA study (NCT03119805) of consecutive adult patients with definite PsA was performed. Countries were classified into tertiles by gross domestic product (GDP)/capita. Disease activity (Disease Activity in PsA, DAPSA and Minimal Disease Activity, MDA) and their components, disease impact (patient-reported outcomes) and biological disease-modifying antirheumatic drugs (bDMARDs) were analysed per country and compared between the three tertiles of GDP/capita by parametric and non-parametric tests. We also explored the percentage of patients with significant disease activity (DAPSA \>14) and no ongoing bDMARD prescription.Results In 439 patients (50.6\% male, mean age 52.3 years, mean disease duration 10.1 years), disease activity and disease impact were higher in the lowest GDP/capita countries. DAPSA remission and MDA were attained in the lowest tertile in 7.0\% and 18.4\% patients, vs 29.1\% and 49.5\% in the middle tertile and 16.8\% and 41.3\% in the high tertile, respectively (all p\<0.001). bDMARDs use was similar in the tertiles (overall mean 61\%). The overall rate of patients with DAPSA \>14 and no bDMARDs was 18.5\%, and was higher in lower GDP/capita countries (p=0.004).Conclusion PsA patients from countries with the lowest GDP/capita, despite similar use of bDMARDs, were more likely to have high disease activity and worse disease impact. There is a need for more equity in healthcare.Data are available on reasonable request. The ReFlaP data are available from the last author on reasonable request.}, URL = {https://rmdopen.bmj.com/content/8/1/e002031}, eprint = {https://rmdopen.bmj.com/content/8/1/e002031.full.pdf}, journal = {RMD Open} }