van Mens LJJ, et al. - The current clinical practice of defining residual disease and subsequent treatment decisions made in psoriatic arthritis (PsA) patients are evaluated in this study. When scored by the treating rheumatologist, remaining disease activity is present in almost two-thirds of patients, but triggers treatment adjustment in only a minority. Further research to comprehend why disease activity does not lead to treatment adjustment is required to enable implementation of treatment strategies in clinical practice.

Methods

• For this research, they designed a cross-sectional study.
• This study scored disease activity and treatment decisions prospectively in 142 consecutive PsA patients visiting the outpatient clinic for routine follow up.
• Disease activity parameters were scored by the patient and the treating rheumatologist; the rheumatologist additionally registered his opinion on the presence of remaining disease activity despite current treatment (further mentioned as a remaining disease) and subsequent treatment decisions.

Results

• In this study, 66% (90/142) of patients had remaining disease activity as indicated by the treating rheumatologist.
• Nearly half (46%) of these patients had moderate to high disease activity as per the clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA).
• Residual disease activity was ascertained by joint disease and pain rather than by active psoriasis.
• There were similar demographic and clinical features between groups with or without residual disease.
• Among patients with remaining disease activity, 74% were treated with either a conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) only or a first TNF-inhibiting biological agent, proposing opportunities for treatment modification.
• However, treatment adjustment was initiated in only 21 (23%) of the 90 patients with residual disease.
• When comparing patients with remaining disease activity with and without treatment adjustment, no differences were seen in objective disease activity measures, such as joint counts and patient scores.
• This information recommend that treatment is not adjusted in a large majority of patients with residual disease activity, despite the fact that alternatives for treatment changes are available.