TITLE:
A Needs-Based Rheumatologist Education Program on Treating to Target in Psoriatic Arthritis and Spondyloarthropathy: Insights and Challenges
AUTHORS:
Janet Pope, Linda Wang, Paul Tingey, Angela Montgomery, Art Karasik, Pauline Boulos, Vandana Ahluwalia, Maggie Larche, Sara Haig, Nikhil Chopra, Gina Rohekar, Sherry Rohekar
KEYWORDS:
Education, Seronegative Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Behavioral Change, Outcome Assessments
JOURNAL NAME:
Open Journal of Rheumatology and Autoimmune Diseases,
Vol.7 No.1,
February
10,
2017
ABSTRACT: Objectives: To determine if
comparative practice data and education for rheumatologists would change
physician behavior for monitoring and treating psoriatic arthritis (PsA) and
spondyloarthritis (SpA). Methods: Participating rheumatologists each performed
a chart audit on 20 patients with PsA and SpA. Accredited education (determined
by a survey and chart audits) and results of chart audits (comparing to other
rheumatologists) were provided for each participant (intervention). Eight
months later, a repeat chart audit by each participant was conducted on another
20 PsA and SpA patients. Changes in measurements collected, treatment given and
patient characteristics pre and post intervention were analyzed. Results: Nine
rheumatologists received the intervention. At baseline, most routinely
monitored PsA and SpA for clinical and laboratory markers. In PsA, there was no
change post-intervention in performing SJC (96%), TJC (≥91%), ESR (≥70%), CRP (≥73%), and CDAI (25%). In SpA, there were increased
measurements of inflammatory markers (54% pre vs. 61% post for CRP), more NSAID
use and decreased physical exam measures and HAQ but no significant changes.
There were no major treatment differences pre and post intervention including
NSAIDs, DMARDs and biologics. Conclusions: The rheumatologists frequently
performed measurements of disease activity, did not change significantly with
educational intervention so there may have been little room for improvement and
many patients were already in a low disease state. Calculation of composite
scores did not increase in PsA. The validity of physical exam and BASDAI as a
measurement of disease activity were noted as concerns in applying a
treat-to-target approach in SpA. Significance and Innovation: This study did
not show a significant change in behavior for rheumatologists who had education
based on care gaps and needs assessment in psoriatic arthritis and
spondyloarthropathy. The rheumatologists identified that disease activity is
difficult to determine with usual care in SpA and thought some measures lacked
validity.