MDA: Aiming for Perfection in PsA Save
When it comes to psoriatic arthritis (PsA) clinical trials such as TICOPA (tight control in PsA) have consistently shown that treating to target correlates with improved disease domain and patient reported outcomes. Minimal disease activity (MDA) has become an oft used target and outcome in PsA trials. While many of us measure and record a variety of measures in our patient charts, we may be on our way to demonstrating MDA in practice. Here is a quick review of MDA components and how to capture them for your patients.
- MDA assesses 7 different domains
- You get one point for each domain score you achieve
- MDA = must meet 5/7 components
- Very Low Disease Activity (VLDA) is classified when all 7 components are met.
In reviewing these components you’ll note that you are very likely already collecting most, if not all, of this data.
Tender and swollen joint counts are bread and butter rheumatologist measures. Palpating entheses around the joints is likely something you are already doing for your patients. Approximating body surface area (BSA) involvement of current PsO plaques, is much easier than calculating PASI scores. Your palm print is roughly equal to 1% BSA. using MDA (minimal disease activity) And, for those three PROs (patient reported outcomes,) if you have your patients fill out a RAPID3 while awaiting your evaluation you have collected all the data for your MDA evaluation.
In most clinical trials of PsA, the primary endpoints are either the The American College of Rheumatology 20% improvement (ACR20) response or the Minimal Disease Activity (MDA) response.
This may well be an important measure for both practice and studies. Now, you just need to remember to document your measures!
Are you using MDA in your clinical practice?
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For Enthesitis one can pick Leeds Enthesitis Index (LEI) for a quick clinical assessment: It only involves 3 sites: Lateral elbow, medial femoral condyle and achilles enthesis.
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