Measuring Treat to Target Goals in PsA: What Is the Best Way?

The calculation of very low disease activity should be the primary measurement when determining if treat to target goals in psoriatic arthritis (PsA) have been met, according to a new study.

Remission or inactive disease is oftentimes the recommended target, of which very low disease activity is one such definition. Other definitions include PsA Disease Activity Score (DAPSA), near remission, Disease Activity Index for PsA, and clinical DAPSA remission (cDAPSA).

IF YOU LIKE THIS, READ...

Leading Organizations Release Joint Guideline for Psoriatic Arthritis Treatment

Can Ixekizumab Improve Psoriatic Arthritis Symptoms?

With the exclusion of near remission, the researchers determined how often individuals fulfill these definitions by analyzing data from 2 studies.

One was the Tight Control of PsA study, which included 206 participants with recent-onset disease who received standard and biological disease-modifying antirheumatic drugs (DMARD). The second study was from Italy and included participants who had received biological DMARD.

By comparing the proportions of participants who achieved each of the 4 potential targets, the researchers found that a lower proportion of participants fulfilled the very low disease activity criteria compared with DAPSA or cDAPSA remission. Meanwhile, the PsA Disease Activity Score results were different between the cohorts.

While residual active disease was low across all definitions, higher levels were seen in DAPSA and cDAPSA compared with very low disease activity, particularly for psoriasis.

Further, the proportion of participants with elevated C-reactive protein was similar—and low—across the 4 treat to target measurements.

“Very low disease activity appears the most stringent measure,” the researchers concluded. “It ensures that significant active arthritis, enthesitis, and psoriasis are not present, in contrast with DAPSA and PASDAS, in which composite scores can ‘hide’ active disease in some domains.”

—Colleen Murphy

Reference:

Coates LC, Lubrano E, Perrotta FM, Emery P, Conaghan PG, Helliwell PS. What should be the primary target of “treat to target” in psoriatic arthritis? J Rheumatol. 2019;46(1):38-42. https://doi.org/10.3899/jrheum.180267.