Psoriatic arthritis managed with tight control in a treat-to-target approach significantly improves joint outcomes for newly diagnosed patients, according to research published in The Lancet.
The TICOPA study (Tight Control of Inflammation in Early Psoriatic Arthritis) is the first to show that a treat-to-target approach can improve clinical outcomes for patients with early psoriatic arthritis.
When weighing the treatment outcomes against the costs of the more rigorous treatment approach, determining the best approach of care for patients can be complex, according to study researcher Laura Coates, MRCP, from the Leeds Institute of Rheumatic and Musculoskeletal Medicine in the United Kingdom, and colleagues.
“Physicians might be reluctant to treat-to-target in patients with psoriatic arthritis, or even to treat these patients at all,” the researchers wrote. “This reluctance to treat affected patients might be due to a perception that psoriatic arthritis is not a progressive disabling disease, despite evidence showing that its consequences are similar to those of rheumatoid arthritis.”
For this trial, 206 patients aged ≥ 18 years with early psoriatic arthritis (< 24 months symptom duration) were randomly assigned to receive tight control (n=101) or standard care (n=105). Patients receiving tight control were reviewed every 4 weeks and underwent escalated treatment if minimal disease activity criteria were not met with the drugs methotrexate, sulfasalazine, ciclosporin A, and/or leflunomide. Standard care was conducted with standard therapy according to the treating clinician with review every 12 weeks.
The tight control group had a better chance of reaching a 20% improvement in symptoms (an American College of Rheumatology response of 20%, ACR20) at 48 weeks than the standard treatment group (OR 1.91; 95% CI: 1.03-3.55; P=.0392). The tight control group also had a better chance of reaching ACR50 than the standard treatment group (OR 2.36; 95% CI: 1.25-4.47; P=.0081) and ACR70 (OR 2.64; 95% CI: 1.32-5.26; P=.0058).