THU0288 Implementation of the treat to target concept in evaluation of psoriatic arthritis patients
Authors: M. Abu Elhija, A. Haddad, I. Lavi, T. Gazitt, D. Zisman
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Minimal disease activity (MDA) in psoriatic arthritis (PsA) is a composite outcome measure that represents the multifaceted domains of psoriatic disease including the joints, enthesis and skin, as well as patient's reported outcomes (PRO). MDA is currently used as a goal of treatment in the "treat-to-target" (T2T) approach in PsA management.<sup> 1</sup> <h3>Objectives</h3> To assess the implementation of the T2T concept in PsA patients. <h3>Methods</h3> A retrospective analysis of all the patients included in a PsA registry during 2016- 2017 was performed. Medical charts were reviewed by an independent rheumatologist and the following data were collected: patient demographics, duration of PsA and psoriasis, alcohol and tobacco use, treatment changes, as well as items that constitute the MDA including the tender and swollen joint count, enthesitis, psoriasis area skin score (PASI), physician and patient evaluation of disease activity and pain and the health assessment questionnaire (HAQ) score. Medical records were reviewed to assess whether T2T concept was indeed followed by the treating rheumatologist to determinate whether MDA was achieved and medication changes were made. The associations between T2T concept implementation and categorical and continuous variables were assessed by Chi square test, or t-test as appropriate. The association between the physician's assessment at each visit with each of the MDA parameters (active versus inactive) was assessed by Chi square test. <h3>Results</h3> The records of 117 consecutive patients were evaluated, one patient was excluded due to lack of data. The mean age was 58.4±13 years, of whom 76 (65.5%) were women. The T2T approach was implemented in 76 (65.5%) patients. There was no correlation between the T2T implementation and patient age, gender, alcohol and tobacco use, disease activity parameters at the patient's visit and the various treatment regimens. The physician assessment of disease activity did not correlate with the MDA score in 40 (34.5%) patients. In most cases 30 (75%), this discrepancy occurred because physicians labelled patients as having inactive disease while disregarding the PRO category of the MDA score, including 29 patients who reported a high VAS pain score, 22 patients reporting a high patient global disease activity and 25 patients reporting a high HAQ- score. In the other 10 (25%) of cases, the treating rheumatologists made treatment changes because they considered patients as having active disease based on one tender or swollen joint or enthesis, despite these patients actually meeting MDA criteria. <h3>Conclusions</h3> In our cohort, the T2T concept was implemented in 65.5% of the visits in accordance with other PsA studies. The main obstacle that we encountered in implementation of MDA concept was in physicians' overlooking the PRO components of the score. Efforts are needed to increase the accurate use of the MDA score and treat to target concept in daily practice. <h3>Reference</h3> [1] Gossec L, McGonagle D, Korotaeva T, Lubrano E, de Miguel E, Østergaard M, Behrens F. Minimal Disease Activity as a Treatment Target in Psoriatic Arthritis: A Review of the Literature. J Rheumatol2018Jan;45(1):6–13. <h3>Disclosure of Interest</h3> None declared