Coates and fellow researchers1 in the UK have determined that when it comes to treat-to-target, very low disease activity (VLDA) is the optimal target in psoriatic arthritis (PsA).
An international task force recommended in 2013 that the target for treatment in PsA should be clinical remission/inactive disease of musculoskeletal involvement, including arthritis, dactylitis, enthesitis, and axial disease. Since 2013, the Tight Control of PsA (TICOPA) criteria have improved clinical and patient-reported outcomes in PsA, using minimal disease activity as a target, while drug-related adverse events have increased.
The authors sought to determine which patients fulfill the criteria of VLDA and remission as well as how much residual disease is present.
The investigators examined data from the TICOPA randomized controlled trial and an Italian real-life data set of patients with PsA. Four definitions of remission/inactive disease were used: VLDA, Disease Activity Index for PsA (DAPSA) remission, clinical DAPSA remission, and near remission in the PsA Disease Activity Score (PASDAS). Proportions of subjects achieving each criterion were calculated.
Only patients with full data sets were in the final analysis. A total of 170 patients were included.
Next: the results and take-home points for clinicians
1. Coates LC, Lubrano E, Perrotta FM, et al. What should be the primary target of “treat to target” in psoriatic arthritis? J Rheumatol. 2019;46:38-42. doi: 10.3899/jrheum.180267. Epub 2018 Sep 15.