PMID- 34884369
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20211214
IS  - 2077-0383 (Print)
IS  - 2077-0383 (Electronic)
IS  - 2077-0383 (Linking)
VI  - 10
IP  - 23
DP  - 2021 Nov 30
TI  - Implementation of the Treat-to-Target Concept in Evaluation of Psoriatic 
      Arthritis Patients.
LID - 10.3390/jcm10235659 [doi]
LID - 5659
AB  - 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.
FAU - Gazitt, Tal
AU  - Gazitt T
AUID- ORCID: 0000-0001-8612-2698
AD  - Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
AD  - Division of Rheumatology, Department of Medicine, University of Washington 
      Medical Center, Seattle, WA 98195, USA.
FAU - Elhija, Muhanad Abu
AU  - Elhija MA
AD  - Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
FAU - Haddad, Amir
AU  - Haddad A
AD  - Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
FAU - Lavi, Idit
AU  - Lavi I
AD  - Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa 
      3436212, Israel.
FAU - Elias, Muna
AU  - Elias M
AD  - Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
FAU - Zisman, Devy
AU  - Zisman D
AUID- ORCID: 0000-0003-0523-2292
AD  - Rheumatology Unit, Carmel Medical Center, Haifa 3436212, Israel.
AD  - The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa 3525433, 
      Israel.
LA  - eng
PT  - Journal Article
DEP - 20211130
PL  - Switzerland
TA  - J Clin Med
JT  - Journal of clinical medicine
JID - 101606588
PMC - PMC8658564
OTO - NOTNLM
OT  - assessment
OT  - composite disease activity measures
OT  - disease activity
OT  - patient-reported outcomes
OT  - psoriatic arthritis
COIS- The authors declare no conflict of interest.
EDAT- 2021/12/11 06:00
MHDA- 2021/12/11 06:01
PMCR- 2021/11/30
CRDT- 2021/12/10 01:03
PHST- 2021/10/10 00:00 [received]
PHST- 2021/11/11 00:00 [revised]
PHST- 2021/11/28 00:00 [accepted]
PHST- 2021/12/10 01:03 [entrez]
PHST- 2021/12/11 06:00 [pubmed]
PHST- 2021/12/11 06:01 [medline]
PHST- 2021/11/30 00:00 [pmc-release]
AID - jcm10235659 [pii]
AID - jcm-10-05659 [pii]
AID - 10.3390/jcm10235659 [doi]
PST - epublish
SO  - J Clin Med. 2021 Nov 30;10(23):5659. doi: 10.3390/jcm10235659.