Background/Purpose: To assess the implementation of the “Treat-to-Target” (T2T) concept using validated composite disease activity scores in daily management of psoriatic arthritis (PsA).

Methods: A retrospective analysis of 117 consecutive PsA patient visits during 2016-2017 was performed including patient demographics, clinical disease parameters used in the Minimal Disease Activity (MDA) and Disease Activity Index for PSoriatic Arthritis  (DAPSA) composite scores, medication use, comorbidities including osteoarthritis (OA) and fibromyalgia syndrome (FMS)  and treatment changes as recorded by the treating physicians.  Medical records were reviewed to assess whether T2T concept was implemented.    All associations were assessed using Chi square test, or Students’ t-test, as appropriate.  Pearson’s correlation, McNemar and Cohen’s kappa measures test were used to evaluate association and agreement between MDA and DAPSA parameters. 

Results: Patient visits with complete data for MDA and DAPSA (116 and 114 visits, respectively) were analyzed with mean age 58.4±13 years, 65.5% women.  T2T approach was implemented in 76 (65.5%) and 74 (64.9%) patient visits using MDA and DAPSA, respectively (Pearson’s correlation -0.695). There was no correlation between T2T implementation and patient age, gender, alcohol and tobacco use, disease activity parameters and the various treatment regimens chosen. Physician assessment of disease activity and treatment changes did not correlate with the MDA score in 40 (34.5%) patients.  In 30 of these cases (75%), the MDA status was over-estimated due to disregard of patient reported outcomes (PRO).  Underestimation of the MDA status occurred in 10 cases (25%) and could be attributed to treatment changes made in patients having < 2 active joints or entheses.  Underestimation of disease activity using DAPSA score occurred in 22 (19.3%) patients and could be attributed to disregarding tender joint count, patient pain visual analogue scale and C-reactive protein level.   The co-existence of FMS or OA was associated with worse DAPSA scores in PsA patients (p=0.031, p=0.026, respectively), but did not affect MDA status.  Achieving disease remission as a goal using the MDA score was more difficult compared to the use of the DAPSA score (Cohen’s kappa=0.489).     

Conclusion: In our cohort, T2T concept was implemented in about 65% of patients.  The main obstacle observed in T2T implementation was the lack of use of validated, practical disease activity scores such as MDA or DAPSA and physicians’ overlooking “subjective” components of these scores in daily practice.  Efforts should be made in order to increase physician reliance and use of validated composite scores in PsA patient management.

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessment-of-implementation-of-treat-to-target-concept-using-validated-composite-scores-in-psoriatic-arthritis-patients/