A Needs-based Rheumatologist Education Program on Treating to Target in Psoriatic Arthritis and Spondylarthropathy: Insights, Challenges, and Future Directions

Objectives: To determine ifcomparative practice data and education for rheumatologists would changephysician behavior for monitoring and treating psoriatic arthritis (PsA) andspondyloarthritis (SpA). Methods: Participating rheumatologists each performeda chart audit on 20 patients with PsA and SpA. Accredited education (determinedby a survey and chart audits) and results of chart audits (comparing to otherrheumatologists) were provided for each participant (intervention). Eightmonths later, a repeat chart audit by each participant was conducted on another20 PsA and SpA patients. Changes in measurements collected, treatment given andpatient characteristics pre and post intervention were analyzed. Results: Ninerheumatologists received the intervention. At baseline, most routinelymonitored PsA and SpA for clinical and laboratory markers. In PsA, there was nochange post-intervention in performing SJC (96%), TJC (≥91%), ESR (≥70%), CRP (≥73%), and CDAI (25%). In SpA, there were increasedmeasurements of inflammatory markers (54% pre vs. 61% post for CRP), more NSAIDuse and decreased physical exam measures and HAQ but no significant changes.There were no major treatment differences pre and post intervention includingNSAIDs, DMARDs and biologics. Conclusions: The rheumatologists frequentlyperformed measurements of disease activity, did not change significantly witheducational intervention so there may have been little room for improvement andmany patients were already in a low disease state. Calculation of compositescores did not increase in PsA. The validity of physical exam and BASDAI as ameasurement of disease activity were noted as concerns in applying atreat-to-target approach in SpA. Significance and Innovation: This study didnot show a significant change in behavior for rheumatologists who had educationbased on care gaps and needs assessment in psoriatic arthritis andspondyloarthropathy. The rheumatologists identified that disease activity isdifficult to determine with usual care in SpA and thought some measures lackedvalidity.