How do patient-reported outcome measures affect treatment intensification and patient satisfaction in the management of psoriatic arthritis? A cross sectional study of 503 patients

Objectives The AsseSSing Impact in pSoriatic Treatment (ASSIST) study investigated prescribing in routine PsA care and whether the patient-reported outcome—PsA Impact of Disease questionnaire (PsAID-12)—impacted treatment. This study also assessed a range of patient and clinician factors and their relationship to PsAID-12 scoring and treatment modification. Methods Patients with PsA were selected across the UK and Europe between July 2021 and March 2022. Patients completed the PsAID questionnaire and the results were shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded. Results A total of 503 patients were recruited. Some 36.2% had changes made to treatment, and 88.8% of these had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; increase in PSAID-12 score is associated with increased odds of treatment escalation (odds ratio 1.58; P < 0.0001). However, most clinicians reported that PsAID-12 did not impact their decision to escalate treatment, instead supporting treatment reduction decisions. Physician’s assessment of disease activity had the most statistically significant effect on likelihood of treatment escalation (odds ratio 2.68, per 1-point score increase). Escalation was more likely in patients not treated with biologic therapies. Additional factors associated with treatment escalation included: patient characteristics, physician characteristics, disease activity and disease impact. Conclusion This study highlights multiple factors impacting treatment decision-making for individuals with PsA. PsAID-12 scoring correlates with multiple measures of disease severity and odds of treatment escalation. However, most clinicians reported that the PsAID-12 did not influence treatment escalation decisions. Psoriatic Arthritis Impact of Disease (PsAID) scoring could be used to increase confidence in treatment de-escalation

An international multicentre analysis of current prescribing practices and shared decision-making in psoriatic arthritis

Objectives Shared decision-making (SDM) is advocated to improve patient outcomes in PsA. We analysed current prescribing practices and the extent of SDM in PsA across Europe. Methods The ASSIST study was a cross-sectional observational study of PsA patients ≥18 years of age attending face-to-face appointments between July 2021 and March 2022. Patient demographics, current treatment and treatment decisions were recorded. SDM was measured by the clinician’s effort to collaborate (CollaboRATE questionnaire) and patient communication confidence (PEPPI-5 tool). Results A total of 503 patients were included from 24 centres across the UK, France, Germany, Italy and Spain. Physician- and patient-reported measures of disease activity were highest in the UK. Conventional synthetic DMARDs constituted a higher percentage of current PsA treatment in the UK than continental Europe (66.4% vs 44.9%), which differed from biologic DMARDs (36.4% vs 64.4%). Implementing treatment escalation was most common in the UK. CollaboRATE and PEPPI-5 scores were high across centres. Of 31 patients with low CollaboRATE scores (<4.5), no patients with low PsAID-12 scores (<5) had treatment escalation. However, of 465 patients with CollaboRATE scores ≥4.5, 59 patients with low PsAID-12 scores received treatment escalation. Conclusions Higher rates of treatment escalation seen in the UK may be explained by higher disease activity and a younger cohort. High levels of collaboration in face-to-face PsA consultations suggests effective implementation of the SDM approach. Our data indicate that in patients with mild disease activity, only those with higher perceived collaboration underwent treatment escalation. Prospective studies should examine the impact of SDM on PsA patient outcomes

Biomarqueurs dans le rhumatisme psoriasique : revue systématique et méta-analyse

Objectif : nous avons réalisé une revue systématique de la littérature associée à une méta-analyse afin d’identifier des biomarqueurs spécifiques du diagnostic et de l’activité du RPso. Méthodes : nous nous sommes appuyés sur les recommandations PRISMA et avons effectué une recherche systématique dans plusieurs bases de données en avril 2021. Certains mots-clés choisis a priori ont été utilisés. Les données concernant les différents biomarqueurs étudiés et les populations concernées ont été extraites. Une méta-analyse a été effectuée lorsque les données concernant un biomarqueur d’intérêt diagnostique ou pronostique étaient rapportées dans plus de 3 cohortes. Résultats : 1445 articles ont été répertoriés dont 107 inclus dans notre revue systématique de la littérature. COMP apparait comme intéressant pour distinguer le RPso dans une population saine avec une forte Différence Standardisée des Moyennes (DSM) de 2,305 [0,795 - 3,816]. MMP3 montre une DSM non significative dans la distinction entre RPso et CS, mais confirme une différence significative entre RPso et PsO (DSM = 0,419 [0,119, 0,719] ; p = 0,006). Les anticorps anti-ADAMTS5 et anti-LL37 ont été rapportés comme associés au RPso dans les populations PsO avec une bonne précision diagnostique (AUC : 0,87 ; p < 0,01 et 0,81 ; p < 0,01, respectivement).Conclusion : les résultats de cette revue systématique avec méta-analyse ne permettent pas de conclure quant à l’existence d’un biomarqueur d’intérêt pour le diagnostic du RPso. Il n’apparait pas de biomarqueurs spécifiques de l’activité de la maladie. De plus amples recherches sont nécessaires, notamment afin d’évaluer la performance d’un biomarqueur dans la distinction entre le RPso et l’arthrose ou d’autres RIC