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Coyle C, Watson L, Whately-Smith C, Brooke M, Kiltz U, Lubrano E, Queiro R, Trigos D, Brandt-Juergens J, Choy E, D'Angelo S, Delle Sedie A, Dernis E, Wirth T, Guis S, Helliwell P, Ho P, Hueber A, Joven B, Koehm M, Morales CM, Packham J, Pinto Tasende JA, Garcia FJR, Ruyssen-Witrand A, Scrivo R, Twigg S, Welcker M, Soubrier M, Gossec L, Coates LC. 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. Rheumatology (Oxford) 2024:kead679. [PMID: 38191998 DOI: 10.1093/rheumatology/kead679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES The ASSIST study investigated prescribing in routine psoriatic arthritis (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-March 2022. Patients completed the PsAID questionnaire, with the results shared with their physician. Patient characteristics, disease activity, current treatment methods, treatment strategies, medication changes and patient satisfaction scores were recorded. RESULTS 503 patients recruited. 36.2% had changes made to treatment, 88.8% of this had treatment escalation. Overall, the mean PsAID-12 score was higher for patients with treatment escalation; the PsAID-12 score was associated with odds of treatment escalation (OR: 1.58; p< 0.0001). However, most clinicians reported 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, (OR = 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 the PsAID-12 did not influence treatment escalation decisions. PsAID scoring could be used to increase confidence in treatment de-escalation.
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Affiliation(s)
- Conor Coyle
- Oxford University, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Lily Watson
- University of Bristol, Department of Cellular and Molecular Medicine, Bristol, UK
| | | | - Mel Brooke
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Uta Kiltz
- Ruhr-Universität Bochum, and Rheumazentrum Ruhrgebiet, Bochum, Germany
| | - Ennio Lubrano
- Academic Rheumatology Unit, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Ruben Queiro
- Rheumatology & ISPA Translational Immunology Division, Faculty of Medicine, Rheumatology Service & the Principality of Asturias Institute for Health Research (ISPA), Universidad de Oviedo, Oviedo, Spain
| | | | - Jan Brandt-Juergens
- Rheumatologische Schwerpunktpraxis, Bundesallee 104/105, Berlin, 12161, Germany
| | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | | | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emmanuelle Dernis
- Rheumatology Department, Centre Hospitalier du Mans, Le Mans, France
| | - Théo Wirth
- Rheumatology Department, INSERM UMRs1097 Autoimmune Arthritis, Aix Marseille University, Marseille, France
| | - Sandrine Guis
- Rheumatology department, Aix Marseille University, Arthrites Autoimmunes, Marseille, France
| | - Philip Helliwell
- University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK
| | - Pauline Ho
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Axel Hueber
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Beatriz Joven
- Rheumatology Department, Hospital Universitario 12 Octubre, Madrid, ES. & Universidad Complutense de Madrid, Avda de Córdoba sin, Madrid, 28041, Spain
| | - Michaela Koehm
- Rheumatology, Universitiy Hospital Frankfurt, Fraunhofer-Institute for Translational Medicine and Cluster of Excellence Immune-Mediated Diseases CIMD, Frankfurt am Main, Germany
| | | | - Jon Packham
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, UK
| | | | | | - Adeline Ruyssen-Witrand
- Rheumatology Center, Toulouse University Hospital, CIC 1436 Inserm, Rheumatology, Tolouse, France & Paul Sabatier University, Toulouse III Toulouse, France
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sarah Twigg
- Rheumatology, Bradford Teaching Hospitals NHS foundation trust, Bradford, UK
| | - Martin Welcker
- MVZ für Rheumat ologie Dr M. Welcker GmbH, Bahnhofstr. 32, Planegg, 82152, Germany
| | - Martin Soubrier
- Rheumatology Departement, Gabriel-Montpied Teaching Hospital of Clermont-Ferrand, France
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, FR. & AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Watson L, Coyle C, Whately-Smith C, Brooke M, Kiltz U, Lubrano E, Queiro R, Trigos D, Brandt-Juergens J, Choy E, D'Angelo S, Delle Sedie A, Dernis E, Guis S, Helliwell P, Ho P, Hueber AJ, Joven B, Koehm M, Montilla C, Packham J, Pinto Tasende JA, Ramirez Garcia FJ, Ruyssen-Witrand A, Scrivo R, Twigg S, Soubrier M, Wirth T, Gossec L, Coates LC. An international multi-centre analysis of current prescribing practices and shared decision-making in psoriatic arthritis. Rheumatology (Oxford) 2023:kead621. [PMID: 38011669 DOI: 10.1093/rheumatology/kead621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/02/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
OBJECTIVES Shared decision-making (SDM) is advocated to improve patient outcomes in Psoriatic arthritis (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 aged ≥18 years attending face-to-face appointments between July 2021-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 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 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. TRIAL REGISTRATION clinicaltrials.gov, NCT05171270.
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Affiliation(s)
- Lily Watson
- Department of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Conor Coyle
- Oxford University Hospital, University of Oxford, Oxford, UK
| | | | - Melanie Brooke
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals, Bath, UK
| | - Uta Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Germany
- Ruhr-University Bochum, Claudiusstr 45, Herne, Germany
| | - Ennio Lubrano
- Academic Rheumatology Unit, Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Rubén Queiro
- Rheumatology & ISPA Translational Immunology Division., Hospital Universitario Central de Asturias, Oviedo-Asturias, Spain
| | | | | | - Ernest Choy
- CREATE Centre, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Salvatore D'Angelo
- Rheumatology Department of Lucania, San Carlo Hospital of Potenza, Potenza, Italy
| | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Emmanuelle Dernis
- Rheumatology Department, Centre Hospitalier du Mans, Le Mans, France
| | - Sandrine Guis
- Rheumatology Department, CHU Marseille, Marseille, France
| | | | - Pauline Ho
- The Kellgren Centre for Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Axel J Hueber
- Division of Rheumatology, Paracelsus Medical University, Klinikum Nürnberg, Nuremberg, Germany
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario, 12 de Octubre, Madrid, Spain
- Universidad Complutense de Madrid, Madrid, Spain
| | - Michaela Koehm
- Division of Rheumatology, Goethe University, Frankfurt, Frankfurt am Main, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP & Fraunhofer Centre of Excellence Immunemediated Diseaes CIMD, Frankfurt am Main, Germany
| | - Carlos Montilla
- Rheumatology Department, Hospital Universitario Salamanca, Salamanca, Spain
| | - Jon Packham
- Academic Unit of Population and Lifespan Sciences, University of Nottingham, Nottingham, UK
| | | | | | - Adeline Ruyssen-Witrand
- Rheumatology Centre, Toulouse University Hospital, Toulouse, France
- Paul Sabatier University, Toulouse III, Toulouse, France
| | - Rossana Scrivo
- Rheumatology Unit, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sarah Twigg
- Rheumatology, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Martin Soubrier
- Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Théo Wirth
- Rheumatology Department, CHU Marseille, Marseille, France
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
- AP-HP, Pitié-Salpêtrière hospital, Rheumatology department, Paris, France
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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