Aussie study finds PsA disease activity reported by patients aligns closely with data collected by physicians face-to-face.
A new Australian study has found “good agreement” between patient-reported assessment of psoriatic arthritis (PsA) index data and physician-led clinical measures of disease activity.
The findings suggest this may improve the efficiency of traditional consultations, benefit patient awareness of their condition, facilitate shared decision-making and help in settings such as telehealth when direct contact is not possible.
Study lead Dr Louise Ward, of Royal North Shore Hospital’s rheumatology department in Sydney, told Rheumatology Republic she was pleased with the findings and their implications.
“I guess we did anticipate there would be good correlation, but it was pleasing to see that it was such a close correlation and that the patient-reported outcome measures could offer such good discrimination for levels of disease activity in psoriatic arthritis,” she said.
“And it further highlights the importance of patient-centred care and the involvement of patients in the process.”
The study, published in International Journal of Rheumatic Diseases, compared the routine assessment of patient index data 3 (RAPID3), an efficient tool comprising patient self-assessment, with traditional clinician-led composite measures used in a PsA clinic setting.
While a treat-to-target (T2T) strategy is recommended for the management of PsA, there is a lack of agreement about the best measure of disease activity to target. The physician assessments included in traditional indices can be complex and time consuming to complete, and cannot readily be conducted during a telehealth consult.
“Patient-reported outcome measures (PROMs) such as RAPID3 present an opportunity for improved patient-centred care with applications in multiple healthcare models,” the study authors argued. “Patients have observed that completion of PROMs prior to a physician consultation can increase the efficiency of the appointment with the rheumatologist.
“PROMs also have the potential to facilitate shared decision-making, guide patient-physician communication and provide feedback for progress over time. The application of PROMs in settings independent of traditional appointments [such as telehealth] presents a promising opportunity to empower patients.”
Self-monitoring could, for example, counter key challenges faced by PsA and psoriasis patients such as fear of deterioration, lack of control and disempowerment through a lack of personalised care.
The study’s researchers collected prospective data between July 2016 and March 2020 from two PsA clinics in Sydney. All rheumatologists received training to perform clinical assessments to calculate the disease activity measures.
The researchers then compared RAPID3 scores with composite scores for minimal disease activity (MDA), very low disease activity (VLDA) and disease activity in psoriatic arthritis (DAPSA) in low disease activity or remission.
Ninety-three patients had simultaneous collection of RAPID3 and MDA measures. Mean age was around 50 years, just over 50% were male and one in four had erosive disease at baseline. RAPID3 scores ≤3.2 and ≤2.7 (range 0-30) had high sensitivity and specificity for VLDA and DAPSA remission respectively.
While RAPID3 was not specifically designed for use in PsA and so lacks the specific PsA clinical manifestations of psoriasis, enthesitis and axial disease, it has the advantage of established validation in a wide range of rheumatological disorders, meaning wider comparisons can be made.
Using PROMs represented “a feasible and efficient alternate in assessment of disease activity” that would facilitate treat-to-target strategy, the study authors argued, noting that T2T has limited uptake in clinical settings due to barriers that include limitations on time and the need for training.
“The use of remote PROMs in assessment of disease activity has never been more compelling, given the current limitations in face-to-face appointments in the setting of the COVID-19 pandemic,” they wrote.
“Our study supports the use of RAPID3 to estimate disease activity to enable adjustment of therapy to target remission. RAPID3 is a feasible choice of PROM in the busy clinical setting.”
