Implementation of the Treat-to-Target Approach in Psoriatic Arthritis and Its Outcomes in Routine Clinical Practice.

Abstract

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.