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Data from the UPLIFT study show patients with psoriatic arthritis and their physicians see eye-to-eye on most subjects—except for treatment goals.
Patients with psoriatic arthritis (PsA) are in general alignment with their rheumatologists on most parameters of their disease status and care plan—however, there may be differences on what patients and clinicians perceive as key treatment goals for PsA.
In new data presented at the Congress of Clinical Rheumatology (CCR) East 2023 Annual Meeting in Destin, FL this week, a multinational team of investigators observed that nearly 9 in 10 surveyed patients with PsA did not think their disease treatment goals matched that of their rheumatologist’s. The findings helped illuminate disparate understandings of patients’ needs and treatment capabilities throughout the common rheumatic disease.
Led by Pascal Richette, MD, PhD, professor and head of the department of rheumatology at the Lariboisière Hospital in Paris, investigators conducted the Understanding Psoriatic Disease Leveraging Insights for Treatment (UPLIFT) trial to help describe how patients and rheumatologists each perceive the factors contributing to PsA severity, as well as treatment goals and the attributes of ideal therapy. UPLIFT is a web-based survey analysis of adult patients with diagnosed PsA and/or psoriasis, as well as rheumatologists and dermatologists treating said patients.
The survey required respondents provide a ranking of their 3 key contributing factors for PsA severity, treatment goals and ideal therapy attributes; Richette and colleagues conducted a qualitative analysis of the sum of scores and feedback. “Alignment of patient and clinician goals and perceptions of PsA burden and treatment are important to improving disease management,” the team noted.
The analysis presented at CCR East 2023 included 1256 patients with PsA and 450 rheumatologists who participated from March – June 2020. Mean patient age was 42.9 years old; 53.7% were men. A majority (56.2%) of patients’ PsA impacted >4 joints. More than three-fourths (78.8%) reported involvement of their large joints. Approximately half (49.8%) had seen a health care provider in the past year at the time of the survey.
Among surveyed rheumatologists, 59.3% worked in a single-specialty practice. They were primarily located in the US (22.4%), followed by Italy (12.0%) and France (11.8%).
Patients’ top 3 factors contributing to their PsA severity included joint pain (30%), impact on quality of life (21%), and type of symptoms (18%). Among rheumatologists, the top 3 factors they reported for their patients included joint erosion/deformity (48%), number of joints involved (44%), and joint pain or stiffness (30%).
The top 3 treatment goals among patients included reduced joint pain (38%), reduced joint stiffness (27%), and stopped progression of joint damage or erosion (25%). Among rheumatologists, the top 3 goals were disease remission or low disease activity (52%), inhibited disease progression (50%), and reduced joint pain (42%).
Lastly, patients ranked reduced joint pain (29%), long-term use safety (24%), and long-term efficacy (23%) as their 3 most important attributes for an ideal PsA therapy. Rheumatologists ranked achieved remission or low disease activity (49%), long-term efficacy (47%), and long-term safety (36%) as their top 3 ideal therapy attributes.
Investigators did not observe discrepancies among rheumatologists’ treatment goals based on patients’ degree of PsA joint involvement; long-term safety and efficacy were priorities among patients and physicians alike, while patients more greatly preferred joint pain reduction over rheumatologists’ preference for disease remission.
“Top treatment goals for patients were reducing joint pain and stiffness and stopping the progression of joint damage or erosion,” investigators wrote. “Despite general alignment between patient and rheumatologist responses across metrics, 87.1% of patients reported they did not feel that their treatment goals matched those of their current health care provider.”
Richette and colleagues concluded patients with PsA generally agreed with rheumatologists on matters of disease severity burden, treatment goals and what constitutes an ideal treatment—with the abstention being a sense of misalignment from patients on a mutually-prioritized treatment goal plan.
“The findings from this study highlight the necessity of shared decision making, developing methods for treatment goal discussions, and patient-clinician alignment to improve patient outcomes,” they wrote.