Study: Implementing a Treat-to-Target Approach Can Benefit PsA Patients

The researchers urged consideration of T2T strategies for PsA.

A new study published in Cureus showed measuring disease activity with validated tools and treating to target (T2T) in patients with psoriatic arthritis (PsA) is crucial to improving quality of life and better disease control. 

The first-ever retrospective review from Pakistan included 89 patients diagnosed with PsA visiting clinics between January 2020 and February 2023. Patients were monitored using the Disease Activity Index for Psoriatic Arthritis (DAPSA) 28 and Physician Global Assessment (PGA). Within the study population, 43.8% (had axial involvement, 23.6% had dactylitis, and 12.4% had enthesitis. Skin psoriasis was present in 84.3%, 11.2% 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.

The authors reported that 97.7% (85) of patients were on conventional synthetic DMARDs (csDMARDs), with methotrexate used in 77% and fleflunomide used in 8% of patients. Overall, 34.8% (31) were using biological DMARDs (tofacitinib, 33.7%; infliximab, 28.1%; and secukinumab 24.7%). Additionally, 21.1% of patients experienced adverse events with csDMARDs and 3.2% with biological DMARDs. The researchers recorded DAPSA28 in 44.9% and PGA in 100% of study patients. The LDA/remission target was achieved in 50.6% patients, as assessed by PGA or DAPSA28 cutoff. The LDA/remission target was achieved in 51.2% of patients taking csDMARDs and in 74.2% using biological DMARDs.

"Measuring the disease activity using validated tools and treating the patient to target for achieving better disease control and improved quality of life are crucial," the researchers concluded. "Despite the evidence that T2T improves outcomes, it is not widely applied in routine clinical practice. This study highlights the need to implement it in clinical practice to improve patient outcomes."

The retrospective nature of the analysis was cited as a study limitation, and it did not include radiographic progression. 

"Further studies are needed in our population to assess the impact of the T2T approach utilizing formal composite disease activity measures in routine clinical practice in prospective cohorts and determine radiographic progression comparing those who achieved remission/LDA to those who did not," the authors wrote. "It highlights the importance of special clinics for PsA patients. These clinics will help develop the expertise of physicians and other staff to assess and manage patients with PsA."

Source: Din S U, Saeed M, Hameed M R, et al. (December 14, 2023) Implementation of the Treat-to-Target Approach in Psoriatic Arthritis and Its Outcomes in Routine Clinical Practice. Cureus 15(12): e50507. doi:10.7759/cureus.50507