Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis Patients
Background: The treat-to-target approach was recently adopted for psoriatic arthritis (PsA) management. Objective: To assess the implementation of the “treat-to-target” (T2T) concept in daily management of PsA by use of composite scores of disease activity versus clinical judgement alone. Methods: A...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/23/5659 |
| _version_ | 1797507664880599040 |
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| author | Tal Gazitt Muhanad Abu Elhija Amir Haddad Idit Lavi Muna Elias Devy Zisman |
| author_facet | Tal Gazitt Muhanad Abu Elhija Amir Haddad Idit Lavi Muna Elias Devy Zisman |
| author_sort | Tal Gazitt |
| collection | DOAJ |
| description | Background: The treat-to-target approach was recently adopted for psoriatic arthritis (PsA) management. Objective: To assess the implementation of the “treat-to-target” (T2T) concept in daily management of PsA by use of composite scores of disease activity versus clinical judgement alone. Methods: A total of 117 PsA patients from a longitudinal PsA cohort were enrolled consecutively in the study during each patient’s first clinic visit during 2016–2017. Clinic notes from the treating rheumatologist were reviewed by an independent rheumatologist, noting clinical impression of disease activity, treatment changes based on clinical judgement, and rationale. Treatment changes were then compared to the use of formal disease activity parameters in Minimal Disease Activity (MDA) and Disease Activity Index for Psoriatic Arthritis (DAPSA) composite measures. All associations were assessed using the chi-square test or the Mann–Whitney test, as appropriate. Results: The 117 PsA patient cohort consisted of 65.5% women, mean age 58.4 ± 13.6 years. Clinical judgement of treating rheumatologist concorded with MDA and DAPSA in 76 (65.5%) and 74 (64.9%) patients, respectively. Agreement between clinical judgement and composite measure criteria did not correlate with patient age, sex, alcohol/tobacco use, or treatment regimens chosen. Disagreement between physician assessment and MDA occurred in 40 (34.5%) cases: in 30 cases, the MDA status was overestimated due to disregard of patient reported outcomes (PRO), while underestimation of MDA status occurred in 25% of cases with treatment changes made in patients with a single active joint or enthesis. Underestimation of disease activity using DAPSA occurred in 22 cases and could be attributed to disregarding tender joint count, patient pain visual analogue scale and C-reactive protein level. Conclusion: In our cohort, agreement between clinical impression and formal composite measure utilization for implementation of T2T strategy occurred in 65% of patients. Discordance resulted from physicians’ overlooking PRO and emphasizing objective findings when using clinical judgement alone. |
| first_indexed | 2024-03-10T04:51:42Z |
| format | Article |
| id | doaj.art-ca60a387188445eaa0bcde4c70d88038 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T04:51:42Z |
| publishDate | 2021-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-ca60a387188445eaa0bcde4c70d880382023-11-23T02:37:34ZengMDPI AGJournal of Clinical Medicine2077-03832021-11-011023565910.3390/jcm10235659Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis PatientsTal Gazitt0Muhanad Abu Elhija1Amir Haddad2Idit Lavi3Muna Elias4Devy Zisman5Rheumatology Unit, Carmel Medical Center, Haifa 3436212, IsraelRheumatology Unit, Carmel Medical Center, Haifa 3436212, IsraelRheumatology Unit, Carmel Medical Center, Haifa 3436212, IsraelDepartment of Community Medicine and Epidemiology, Carmel Medical Center, Haifa 3436212, IsraelRheumatology Unit, Carmel Medical Center, Haifa 3436212, IsraelRheumatology Unit, Carmel Medical Center, Haifa 3436212, IsraelBackground: The treat-to-target approach was recently adopted for psoriatic arthritis (PsA) management. Objective: To assess the implementation of the “treat-to-target” (T2T) concept in daily management of PsA by use of composite scores of disease activity versus clinical judgement alone. Methods: A total of 117 PsA patients from a longitudinal PsA cohort were enrolled consecutively in the study during each patient’s first clinic visit during 2016–2017. Clinic notes from the treating rheumatologist were reviewed by an independent rheumatologist, noting clinical impression of disease activity, treatment changes based on clinical judgement, and rationale. Treatment changes were then compared to the use of formal disease activity parameters in Minimal Disease Activity (MDA) and Disease Activity Index for Psoriatic Arthritis (DAPSA) composite measures. All associations were assessed using the chi-square test or the Mann–Whitney test, as appropriate. Results: The 117 PsA patient cohort consisted of 65.5% women, mean age 58.4 ± 13.6 years. Clinical judgement of treating rheumatologist concorded with MDA and DAPSA in 76 (65.5%) and 74 (64.9%) patients, respectively. Agreement between clinical judgement and composite measure criteria did not correlate with patient age, sex, alcohol/tobacco use, or treatment regimens chosen. Disagreement between physician assessment and MDA occurred in 40 (34.5%) cases: in 30 cases, the MDA status was overestimated due to disregard of patient reported outcomes (PRO), while underestimation of MDA status occurred in 25% of cases with treatment changes made in patients with a single active joint or enthesis. Underestimation of disease activity using DAPSA occurred in 22 cases and could be attributed to disregarding tender joint count, patient pain visual analogue scale and C-reactive protein level. Conclusion: In our cohort, agreement between clinical impression and formal composite measure utilization for implementation of T2T strategy occurred in 65% of patients. Discordance resulted from physicians’ overlooking PRO and emphasizing objective findings when using clinical judgement alone.https://www.mdpi.com/2077-0383/10/23/5659psoriatic arthritisassessmentdisease activitycomposite disease activity measurespatient-reported outcomes |
| spellingShingle | Tal Gazitt Muhanad Abu Elhija Amir Haddad Idit Lavi Muna Elias Devy Zisman Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis Patients Journal of Clinical Medicine psoriatic arthritis assessment disease activity composite disease activity measures patient-reported outcomes |
| title | Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis Patients |
| title_full | Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis Patients |
| title_fullStr | Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis Patients |
| title_full_unstemmed | Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis Patients |
| title_short | Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic Arthritis Patients |
| title_sort | implementation of the treat to target concept in evaluation of psoriatic arthritis patients |
| topic | psoriatic arthritis assessment disease activity composite disease activity measures patient-reported outcomes |
| url | https://www.mdpi.com/2077-0383/10/23/5659 |
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