PhD defence S.V.J. (Selinde) Snoeck Henkemans

Below is a brief summary of the dissertation:

This thesis investigated the disease course of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients. The first part focused on the importance of early diagnosis and treatment. In PsA, a therapeutic "window of opportunity" was identified: diagnosis and treatment within one year of the onset of musculoskeletal symptoms were associated with better clinical outcomes. The greatest delay occurred at the physician level, highlighting the need for earlier recognition of PsA. In RA, achieving and maintaining remission during the first year after diagnosis was associated with sustained improvements in quality of life, reduced pain and fatigue, and better physical functioning compared with low disease activity. Similarly, in PsA, early achievement of minimal disease activity (MDA) was associated with better patient-reported outcomes. Although the overall disease burden was comparable between RA and PsA, patients with PsA experienced greater functional impairment and poorer mental health than patients with RA after one year of treatment.

The second part focused on disease monitoring and prognosis. A combination of patient-reported outcomes was found to be a useful screening tool for identifying active disease and may facilitate remote monitoring in the future. In addition, depressive symptoms in both RA and PsA were associated with a lower likelihood of achieving remission, underscoring the importance of recognizing and addressing mental health in clinical care. Finally, a subgroup of patients with PsA achieved sustained DMARD-free remission without disease flare, suggesting that tapering and discontinuing medication may be feasible and safe in carefully selected patients.