TY - JOUR
T1 - Treatment decisions in axial spondyloarthritis daily clinical practice are more than treat-to-target
AU - Bolt, Janne W.
AU - Aalbers, Caroline J.
AU - Walet, Laura
AU - van Mens, Leonieke J. J.
AU - van Denderen, Christiaan
AU - van der Horst-Bruinsma, Irene
AU - van Baarsen, Lisa G. M.
AU - Landewé, Robert
AU - van de Sande, Marleen G. H.
N1 - Funding Information: This work was supported by the Academic Medical Center Fellowship and a Dutch Organization for Health Research and Development VIDI grant (91718371) to L.v.B. Publisher Copyright: © 2023 The Author(s). Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Objective: 'Treat-to-target principles' are advised for axial spondyloarthritis (axSpA), although a clear target is not yet defined and targets do not always reflect inflammation. Treat-to-target use and motives for treatment choices in clinics are unknown. Therefore, we studied the presence of residual disease activity according physician's opinion, patient's opinion and composite indices and compared them to the subsequent treatment decisions. Methods: This cross-sectional multicentre study included 249 patients with a clinical diagnosis of axSpA ≥6 months. Remission and low disease activity according to the BASDAI (<1.9 and <3.5, respectively) and physician's and patient's opinion were assessed. Questionnaires included patient-reported outcomes and patients and physicians completed questions regarding treatment decisions. Results: A total of 115/249 (46%) patients were in remission according to the physician and 37% (n = 43) of these patients reached remission according to the BASDAI. In 51/83 (60%) of the patients with residual disease activity according to the physician and a BASDAI >3.5 the treatment was left unchanged, either because of low disease activity as rated by the physician [n = 15 (29%)] or because of a combination of low disease activity with non-inflammatory complaints or comorbidities [n = 11 (25%)]. Retrospective treat-to-target evaluations showed that treatments were most frequently intensified in patients with arthritis or inflammatory back pain and less often in patients with other (non-inflammatory) musculoskeletal comorbidities. Conclusion: This study shows that physicians do not always strictly apply treat-to-target in case of residual disease activity in axSpA. Usually, they accept low disease activity as satisfactory.
AB - Objective: 'Treat-to-target principles' are advised for axial spondyloarthritis (axSpA), although a clear target is not yet defined and targets do not always reflect inflammation. Treat-to-target use and motives for treatment choices in clinics are unknown. Therefore, we studied the presence of residual disease activity according physician's opinion, patient's opinion and composite indices and compared them to the subsequent treatment decisions. Methods: This cross-sectional multicentre study included 249 patients with a clinical diagnosis of axSpA ≥6 months. Remission and low disease activity according to the BASDAI (<1.9 and <3.5, respectively) and physician's and patient's opinion were assessed. Questionnaires included patient-reported outcomes and patients and physicians completed questions regarding treatment decisions. Results: A total of 115/249 (46%) patients were in remission according to the physician and 37% (n = 43) of these patients reached remission according to the BASDAI. In 51/83 (60%) of the patients with residual disease activity according to the physician and a BASDAI >3.5 the treatment was left unchanged, either because of low disease activity as rated by the physician [n = 15 (29%)] or because of a combination of low disease activity with non-inflammatory complaints or comorbidities [n = 11 (25%)]. Retrospective treat-to-target evaluations showed that treatments were most frequently intensified in patients with arthritis or inflammatory back pain and less often in patients with other (non-inflammatory) musculoskeletal comorbidities. Conclusion: This study shows that physicians do not always strictly apply treat-to-target in case of residual disease activity in axSpA. Usually, they accept low disease activity as satisfactory.
KW - axial spondyloarthritis
KW - disease activity
KW - treatment decisions
UR - http://www.scopus.com/inward/record.url?scp=85181583959&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/rheumatology/kead155
DO - https://doi.org/10.1093/rheumatology/kead155
M3 - Article
C2 - 37021937
SN - 1462-0324
VL - 63
SP - 34
EP - 40
JO - Rheumatology (United Kingdom)
JF - Rheumatology (United Kingdom)
IS - 1
ER -