Treat-to-target still in ‘too hard basket’ for PsA

Barriers to rheumatologists adopting a treat-to-target approach in psoriatric arthritis (PsA), include lack of time, a feeling it is too difficult and lack of protocols and training, UK researchers have found.

Despite EULAR guidance from 2015 advising a treat-to-target approach in PsA, it has not been widely implemented for reasons that need to be better understood, a study in the Annals of Rheumatic Diseases reports.

The researchers hope to use their findings to develop resources to help rheumatology departments get a treat to target strategy in place.

Speaking with the limbic, study leader Dr Laura Coates, principal investigator at the Oxford Psoriatic Arthritis Centre, said the findings based on a series of interviews and focus groups matched what they had heard anecdotally.

“There were more people who said they needed more training than I thought there would be,” she said. “But the other barriers that we did expect were time and being able to record information quickly and being able to do patient recorded outcomes efficiently before they came in.”

“It wasn’t massively surprising but this is the first step in thinking about the kind of packages we might need and every centre has a slightly different set up.”

The researchers heard from participants that treat-to-target in PsA is a much more complicated process than in rheumatoid arthritis, including around measuring change, agreeing on targets and having the resources to support care.

“Implementation of a T2T approach in PsA will require an integrated approach that addresses the support, training and resource needs of individual clinicians, rheumatology teams, local IT systems and service providers, and aligns with their current priorities, to maximise success,” their study concluded.

Dr Coates added that there is now a need to take COVID-19 into account when planning protocols or other resources for centres to use, for example by thinking about how to include more remote monitoring where possible.

“The idea is to come up with a selection of solutions that might be helpful and that centres can pick and choose from.”

Some feedback had been that it was just too difficult to put in place but the counter view to that there are rheumatologists who are doing it, she explained.

The research also identified that a way to overcome barriers in departments around implementing treat to target for PsA was having a clinical champion.

“It is about sharing best practice. One of the biggest things we identified as an enabler was having someone who would drive it forward because they had an interest. A person in the department saying this is what we’re going to do … a lot of the NHS works like that.”

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