Background/Purpose: With expanding therapeutic possibilities for the treatment of psoriatic arthritis (PsA) it will be increasingly important to determine residual disease and define when to adjust treatment. The rationale behind treatment decisions in current daily clinical practice and the relation with residual disease activity has not been investigated.

The aim of this study was to assess the current clinical practice on defining residual disease and the subsequent treatment decisions made in PsA patients.

Methods: This cross sectional study included 142 consecutive PsA patients who visited the outpatient clinic. The treating rheumatologist scored disease activity and her/his opinion on the presence of residual disease and the subsequent treatment decisions made. Patients scored patient disease activity scores.

Results: Two thirds (90/142) of the patients had musculoskeletal residual disease activity, with half of those having even moderate to high disease activity according to CDAI. There were no differences between the groups with or without residual disease activity in gender, disease duration, comorbidity, current treatment duration or number of previously used cDMARDS. Residual disease activity was more frequently reported in patients treated with a cDMARD only or a 2nd TNFi. 74% of the patients with residual disease activity were currently treated with either a cDMARD only or a first TNFi, suggesting that treatment modification could be an option. Of the 90 patients with residual disease, in 21(23%) treatment adjustment was initiated. Treatment changes were considered less frequent in those patients treated with a 2nd TNFi. No differences were seen in disease activity and demographics between those with or without a treatment adjustment. Judgment by the physician and/or patient rather than objective hurdles to treatment intensification (absence of additional treatment options, lack of compliance, intolerance) drove the decision not to modify treatment.

Conclusion: In almost 2/3 of the patients there was a presence of residual disease activity but only resulted in treatment adjustment in only a minority. As the adjustment could not be explained by comorbidities or a lack of treatment options there is clearly a further need for research to understand why disease activity does not lead to treatment adjustment in these cases.

« Back to 2017 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/residual-disease-activity-in-psoriatic-arthritis-triggers-treatment-adjustment-in-only-a-quarter-of-patients-in-daily-clinical-practice/