How to Achieve Minimal Disease Activity
For most people with psoriatic arthritis, MDA is a worthwhile goal of treatment. “It is specific, measurable, and patient-centered,” says Husni.
It’s important, Husni says, to assess the components of MDA regularly and adjust therapies as needed if the person’s treatment goals aren’t being met. This process should involve discussions with your rheumatologist about what you’re looking to get out of your treatment plan.
Steps you can take that may help guide you toward minimal disease activity include:
- Taking medications as directed, or telling your doctor if you need to stop taking a drug because of side effects
- Clearly describing your symptoms, and how they affect your life, to your doctor
- Learning about treatment options and lifestyle measures for psoriatic arthritis
- Bringing up the idea of trying different therapies if your current treatment isn’t working well enough
In some cases, MDA may not be the best or main goal of treatment for psoriatic arthritis. “For example, a patient may meet MDA but still have severe psoriasis. One domain is severe even if the total MDA score looks acceptable,” says Husni. In that case, adjusting treatment may be important to reduce skin symptoms.
And the opposite situation is possible, too — someone who hasn’t achieved MDA but doesn’t need or want a major change in their treatment. “There may be a patient who says, ‘I’m so much better. My joints are well controlled, my function is fine, but I have ongoing skin disease and a few swollen joints that don’t bother me a lot,’” says Ruderman.
For some people, MDA may not be an appropriate or realistic goal because they have other forms of arthritis or conditions that limit movement or cause pain. “Treatment goals have to be individualized in these cases,” says Rebecca Gordon, MD, a rheumatologist at UCHealth Cherry Creek Medical Center in Denver. “Some patients may make meaningful progress without strictly meeting criteria for MDA.”
Dr. Gordon also notes that for people whose psoriatic arthritis largely affects their spine or surrounding areas, a disease score developed specifically for arthritis in this area may be more useful than MDA for setting goals or assessing treatments.
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