AB0880 OPTIPSA: Nationwide survey on clinical/therapeutic inertia in psoriatic arthritis

Abstract

BackgroundTherapeutic inertia (TI), or clinical inertia, is the medical behavior of not initiating or intensifying treatment when recommended by clinical recommendations (1). TI was established in diabetes and then studied in hypertension, multiple sclerosis and psoriasis, and is estimated to affect 30 to 70% of physicians managing patients with chronic diseases (2-4). To our knowledge, no data have reported TI in the setting of psoriatic arthritis (PsA).ObjectivesThe OPTI PSA survey was conducted to assess therapeutic inertia around PsA in France.Methods825 French rheumatologists were contacted by e-mail between January and March 2021 and asked to complete an online questionnaire, consisting of 7 clinical vignettes illustrating common situations and reflecting the polymorphic character of PsA: five clinical cases (oligoarthritis, enthesitis, polyarthritis, neoplastic history, cardiovascular risk) requiring treatment optimization in accordance with the latest SFR/EULAR recommendations (5, 6,7) and two “control” clinical cases (DIP arthritis, atypical axial) not requiring any change of treatment. The rheumatologists were also questioned about their routine practice and perception of PsA.Results101 (12%) of the rheumatologists contacted completed the questionnaire. Sixty percent of respondents were men, and 45% of rheumatologists were aged between 46 and 60 years; most practiced exclusively in hospitals (34%), private practice (33%) or in both (34%); the mean duration of clinical practice was 23 years. Almost all of the respondents stated that they were comfortable with the management of PsA (99%) and familiar with French and EULAR recommendations (90%). There was general consensus regarding the difficulties inherent in PsA: therapeutic objectives difficult to achieve (74% of respondents); polymorphism making it difficult to evaluate the effectiveness of a treatment (72%). Almost half the respondents (47%) demonstrated TI on at least one of the 5 vignettes that warranted treatment optimization. The clinical cases that induced the most TI were “oligoarthritis” and “enthesitis” with 20% and 19% of respondents not modifying treatment, respectively. Conversely, the vignettes “polyarthritis in relapse”, “neoplastic history” and “cardiovascular risk” generated fewer TIs with 11%, 8% and 6% of respondents, respectively, choosing not to change the current treatment.ConclusionDespite a good knowledge of PsA and associated clinical recommendations, almost half of the rheumatologists we surveyed demonstrated at least one TI. The rate of TI we observed for PsA is similar to published data for other chronic diseases (1-4). The clinical profiles for which there was the least uncertainty (comorbidities and polyarticular involvement) generated the least inertia; the more complex profiles oligoarthritis and enthesitis generated more inertia. Our study is the first to show the existence of clinical inertia in PsA and further research is warranted to ascertain the reasons behind this inertia.