MDA and ACR20 Best Discriminate Treatment Response in PsASpecific measures help identify effective treatments for psoriatic arthritis

Annals of the rheumatic diseases Published August 4, 2026 Study authors: Annfeldt Tommy K, Händel Mina N, Haugegaard Tobias, Henriksen Marius, Coates Laura C, Ogdie Alexis, … PubMed ↗ DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

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Key Takeaway

MDA and ACR20 are the most effective composite measures for distinguishing active treatment from placebo in PsA trials.

A systematic review and meta-analysis evaluated the discriminant capacity of composite outcome measures in psoriatic arthritis (PsA) trials. The analysis included 24 randomized controlled trials with 43 comparisons of biologic or targeted synthetic DMARDs versus placebo.

Head-to-head comparisons revealed that ACR20 was superior to DAPSA (OR 0.80, 95% CI 0.66-0.97), and MDA was superior to DAPSA (OR 0.71, 95% CI 0.57-0.87). PASDAS also outperformed DAPSA (OR 1.35, 95% CI 1.10-1.66).

In a multivariate meta-analysis, MDA (OR 5.06), ACR20 (OR 4.01), PASDAS (OR 3.70), and DAPSA (OR 3.02) showed significantly higher discriminant capacity than CPDAI (OR 1.86). MDA and PASDAS had the highest values, indicating they are most sensitive to treatment effects.

Exploratory analysis suggested ACR70 may have greater discriminant capacity than ACR20 and DAPSA, but these findings are preliminary. Limitations include infrequent reporting of CPDAI and absence of 3-VAS and 4-VAS data.

These results inform the selection of outcome measures for future PsA trials, favoring MDA and ACR20 for detecting treatment response.

How this fits prior evidence

This meta-analysis addresses a gap in identifying the most reliable clinical endpoints for evaluating treatments in psoriatic arthritis. While prior coverage has focused on specific biologics and inhibitors in rheumatoid arthritis, such as JAK and IL-6 inhibitors outperforming TNF inhibitors, this study focuses specifically on the statistical power of different composite outcome measures to distinguish active treatment from placebo.

Living with psoriatic arthritis means dealing with both joint pain and skin issues. When doctors test new medications, they need reliable ways to measure if a treatment is actually working compared to a placebo. This study looked at 24 different trials to see which measurement tools were the most accurate for tracking progress.

The researchers found that some measures are much better than others at showing results. Specifically, measures like MDA and PASDAS showed the highest ability to distinguish active treatments from placebos. Other measures, such as ACR20 and DAPSA, also performed well, while the CPDAI measure was less effective at showing clear differences.

While these findings help doctors understand which tools provide the clearest picture of a patient's progress, some data is still limited. For example, one specific measure, ACR70, came from an exploratory analysis and may not be as established. These results help clarify how to best track success in clinical trials for psoriatic arthritis.

What this means for you:

Certain measurement tools are much better than others at showing if a new drug is working for psoriatic arthritis.

Common questions

Which measurements are most accurate for tracking treatment success?

The study found that MDA and PASDAS had the highest values for distinguishing active treatments from placebo. Other measures like ACR20 and DAPSA also showed better performance than CPDAI when trying to see if a medication was working.

How does the study compare different measurement tools?

The analysis compared several composite outcome measures. It found that MDA, ACR20, PASDAS, and DAPSA all had higher discriminant capacity than CPDAI. This means they are more effective at showing whether a treatment is actually working.

Are there any limitations to these findings?

The study noted that the CPDAI measure was rarely reported in trials. Additionally, some results like ACR70 came from an exploratory analysis rather than a primary finding. Always talk to your doctor about which metrics they use to track your progress.

Study Details

Study typeSystematic review

EvidenceLevel 1

PublishedAug 2026

PMID42248769

View Original Abstract ↓

OBJECTIVES: To identify which composite outcome measure most effectively distinguishes active treatments from placebo in randomised controlled trials (RCTs) of biologic or targeted synthetic disease-modifying antirheumatic drugs (b- or tsDMARDs) for psoriatic arthritis (PsA). METHODS: A systematic literature review (PROSPERO ID: CRD42024578203) of Cochrane Central Register of Controlled Trials and PubMed identified RCTs comparing b- or tsDMARDs with placebo reporting ≥2 of 7 composite outcome measures shortlisted for evaluation by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis-Outcome Measures in Rheumatology (GRAPPA-OMERACT) working group (American College of Rheumatology Response Criteria [ACR], Composite Psoriatic Disease Activity Index [CPDAI], Disease Activity index for PSoriatic Arthritis [DAPSA], Minimal Disease Activity [MDA], Psoriatic Arthritis Disease Activity Score [PASDAS], and 3- and 4-Visual Analogue Scale [VAS]). Discriminant capacities were assessed using odds ratio (OR) for binary outcomes, with continuous outcomes converted from standardised mean differences and analysed through network and multivariate meta-analysis techniques. RESULTS: Of 2483 references, 24 trials were included (43 randomised comparisons). CPDAI was rarely reported, and no RCTs reported 3-VAS and 4-VAS. The main network meta-analysis showed differences in discriminant properties for DAPSA vs ACR20 (OR: 0.80; 95% CI: 0.66-0.97; favouring ACR20), DAPSA vs MDA (OR: 0.71; 0.57-0.87; favouring MDA), and PASDAS vs DAPSA (OR: 1.35; 1.10-1.66; favouring PASDAS). Supported by multivariate meta-analysis: MDA (OR: 5.06; 4.20-6.09), ACR20 (OR: 4.01; 3.41-4.73), PASDAS (OR:3.70; 3.00-4.56), DAPSA (OR: 3.02; 2.44-3.75), and CPDAI (OR: 1.86; 0.95-3.64). Sensitivity analyses confirmed a pattern of consistent numerical advantages for MDA and PASDAS. Exploratory analyses showed ACR70 had more discriminant capacity than ACR20 and DAPSA but not ACR50, MDA, and PASDAS. CONCLUSIONS: ACR20, MDA, and PASDAS demonstrated greater discriminant capacity than DAPSA. Exploratory analyses suggested greater discriminant capacity for ACR70 compared with ACR20 and DAPSA but not with ACR50, MDA or PASDAS.

MDA and ACR20 Best Discriminate Treatment Response in PsASpecific measures help identify effective treatments for psoriatic arthritis

How this fits prior evidence

Common questions

Study Details

Guselkumab Phase III trials validate 3VAS and 4VAS measures for psoriatic arthritis disease activity assessment

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MDA and ACR20 Best Discriminate Treatment Response in PsASpecific measures help identify effective treatments for psoriatic arthritis

How this fits prior evidence

Common questions

More on Rheumatoid Arthritis

Study Details

Guselkumab Phase III trials validate 3VAS and 4VAS measures for psoriatic arthritis disease activity assessment

Study checks how well pain scores track joint damage in psoriatic arthritis patients

Clinical research that matters. Delivered to your inbox.

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