PMID- 38222185
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240116
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 12
DP  - 2023 Dec
TI  - Implementation of the Treat-to-Target Approach in Psoriatic Arthritis and Its 
      Outcomes in Routine Clinical Practice.
PG  - e50507
LID - 10.7759/cureus.50507 [doi]
LID - e50507
AB  - Background Measuring disease activity in psoriatic arthritis using validated 
      tools and treating to a target (T2T) is advocated. It improves quality of life 
      and delays radiographic progression. In clinical practice, it guides therapy 
      escalation to achieve better disease control. This study aimed to assess the 
      real-life implementation of the T2T concept in daily clinical practice and the 
      proportion of patients achieving the target of low disease activity or remission. 
      Methodology In this study, a retrospective review of patients diagnosed with 
      psoriatic arthritis having clinical visits from January 2020 to February 2023 was 
      done. The proportion of patients in whom disease activity was monitored using the 
      Disease Activity Index for Psoriatic Arthritis (DAPSA) 28 and Physician Global 
      Assessment (PGA) and those achieving the target was calculated using SPSS version 
      21 (IBM Corp., Armonk, NY, USA). Results A total of 89 patients were included in 
      the study after fulfilling the inclusion and exclusion criteria. Overall, 56.2% 
      (50) of patients were males and 43.8% (39) were females, with a mean age of 43.5 
      +/- 14.5 years, mean disease duration of 6.6 +/- 3.8 years, and mean follow-up 
      duration of 2.8 +/- 1.6 years. Of the study population, 43.8% (39) had axial 
      involvement, 23.6% (21) had dactylitis, and 12.4% (11) had enthesitis. Skin 
      psoriasis was present in 84.3% (75), 11.2% (10) had a family history of 
      psoriasis, 19.1% (17) had nail changes, 1.1% (1) had uveitis, and in 94.8% (73) 
      of patients skin psoriasis presented before arthritis. Overall, 97.7% (85) of 
      patients were on conventional synthetic disease-modifying antirheumatic drugs 
      (csDMARDs), with the most common being methotrexate in 77%, followed by 
      leflunomide in 8%. Further, 34.8% (31) were using biological DMARDs (bDMARDs), 
      with the most common being tofacitinib (33.7%), infliximab (28.1%), and 
      secukinumab (24.7%) being other choices. Overall, 21.1% (18) of patients 
      experienced adverse events with csDMARDs and 3.2% (1) with biological DMARDs. 
      DAPSA28 was recorded in 44.9% (40), Psoriasis Area and Severity Index in 16.8% 
      (15), and PGA in 100% of patients. Target of low disease activity (LDA)/remission 
      was achieved in 50.6% (45) patients, as assessed by PGA or DAPSA28 cutoff. The 
      LDA/remission target was achieved in 51.2% of patients taking csDMARDs, and 74.2% 
      in those who were on bDMARDs. Conclusions It is crucial to measure the disease 
      activity using validated tools and treat the patient to target for achieving 
      better disease control and improved quality of life. Despite the evidence that 
      T2T improves outcomes, it is not widely practiced in routine clinical practice.
CI  - Copyright (c) 2023, Din et al.
FAU - Din, Shamas U
AU  - Din SU
AD  - Rheumatology, Central Park Teaching Hospital, Central Park Medical College, 
      Lahore, PAK.
FAU - Saeed, Muhammad Ahmed
AU  - Saeed MA
AD  - Rheumatology, Central Park Teaching Hospital, Central Park Medical College, 
      Lahore, PAK.
AD  - Rheumatology, National Hospital and Medical Center, Lahore, PAK.
AD  - Rheumatology, Arthritis Care Foundation, Lahore, PAK.
FAU - Hameed, Muhammad R
AU  - Hameed MR
AD  - Rheumatology, Central Park Teaching Hospital, Central Park Medical College, 
      Lahore, PAK.
FAU - Aamer, Maryam
AU  - Aamer M
AD  - Rheumatology, Central Park Teaching Hospital, Central Park Medical College, 
      Lahore, PAK.
FAU - Arshad, Umbreen
AU  - Arshad U
AD  - Rheumatology, Central Park Teaching Hospital, Central Park Medical College, 
      Lahore, PAK.
FAU - Qamar, Hafiz Yasir
AU  - Qamar HY
AD  - Rheumatology, Central Park Teaching Hospital, Central Park Medical College, 
      Lahore, PAK.
LA  - eng
PT  - Journal Article
DEP - 20231214
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10787382
OTO - NOTNLM
OT  - clinical practice
OT  - dapsa
OT  - disease-modifying anti-rheumatic drugs
OT  - psoriatic arthritis
OT  - treat to target
COIS- The authors have declared that no competing interests exist.
EDAT- 2024/01/15 06:42
MHDA- 2024/01/15 06:43
PMCR- 2023/12/14
CRDT- 2024/01/15 04:30
PHST- 2023/12/14 00:00 [accepted]
PHST- 2024/01/15 06:43 [medline]
PHST- 2024/01/15 06:42 [pubmed]
PHST- 2024/01/15 04:30 [entrez]
PHST- 2023/12/14 00:00 [pmc-release]
AID - 10.7759/cureus.50507 [doi]
PST - epublish
SO  - Cureus. 2023 Dec 14;15(12):e50507. doi: 10.7759/cureus.50507. eCollection 2023 
      Dec.