Abstract
Background:The Treat-To-Target (TTT) approach is an important part of clinical practice in rheumatology. Although this approach is well structured in rheumatoid arthritis (RA) and data are accumulating in psoriatic arthritis (PsA) and axial spondyloarthritides (AxSpA), the systematic application of this process in clinical practice can be further improved to achieve better treatment outcomes.Objective:The aim of this study was to present the perspective of clinical rheumatologists on how they evaluate disease activity, in what patient groups they regularly use treatment targets, and how they prioritize treatment targets in spondyloarthritides.Methods:A questionnaire consisting of eight questions on the management of RA, PsA and AxSpA (4 focusing on the use of indexes when setting treatment targets, 2 on the frequency and the patient groups to which these are being applied, and 2 on the physician’s priorities in managing different manifestations of the SpA spectrum) was completed by private practice and hospital-based rheumatologists.Results:160 rheumatologists completed the questionnaire. The majority use the formal composite indexes in clinical practice, certain items from these indexes, and patients’ evaluation of the treatment intervention. Indexes are applied frequently in most patient groups, and the priorities of rheumatologists include both musculoskeletal manifestations, as well as the other clinical aspects of the SpA spectrum.Conclusion:The results can contribute to the understanding of the adherence of rheumatologists to this TTT strategy.
Highlights
Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritides (AxSpA) are chronic autoimmune diseases of unknown aetiology with no available cure.[1,2,3] The current treatment options aim to abrogate inflammation as clinically manifested in the affected tissues and organs, and control the structural damage through a treat-to-target approach.[4,5] This strategy is gradually being implemented in rheumatoid arthritis (RA), after proven benefits have been shown in diseases like diabetes mellitus and arterial hypertension, aiming at an optimisation of outcomes in patients with chronic diseases with increasing burden in the course of the disease
In AxSpA, the recommendation is against using an Ankylosing Spondylitis Disease Activity Score (ASDAS)-based treat-to-target strategy in favour of a physician-based assessment, and the expert panel judged that more convincing evidence is required to stablish the benefits and risks of treating to target in the context of fewer therapeutic options
We describe the current priorities, the way each disease status is being evaluated, and the extent of application of treat-to-target strategy as described by the perception of clinical rheumatologists
Summary
Rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritides (AxSpA) are chronic autoimmune diseases of unknown aetiology with no available cure.[1,2,3] The current treatment options aim to abrogate inflammation as clinically manifested in the affected tissues and organs, and control the structural damage through a treat-to-target approach.[4,5] This strategy is gradually being implemented in RA, after proven benefits have been shown in diseases like diabetes mellitus and arterial hypertension, aiming at an optimisation of outcomes in patients with chronic diseases with increasing burden in the course of the disease. The trend towards using indexes that are more stringent and simple to use in various settings reflects the ambition to further elevate the level of standards of care, especially as more therapeutic options become available In this manuscript, we describe the current priorities, the way each disease status is being evaluated, and the extent of application of treat-to-target strategy as described by the perception of clinical rheumatologists. Methods: A questionnaire consisting of eight questions on the management of RA, PsA and AxSpA (4 focusing on the use of indexes when setting treatment targets, 2 on the frequency and the patient groups to which these are being applied, and 2 on the physician’s priorities in managing different manifestations of the SpA spectrum) was completed by private practice and hospital-based rheumatologists. Conclusion: The results can contribute to the understanding of the adherence of rheumatologists to this TTT strategy
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