Treatment decisions in axial spondyloarthritis daily clinical practice are more than treat-to-target.

Autor:	Bolt JW; Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands., Aalbers CJ; Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands., Walet L; Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands., van Mens LJJ; Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands., van Denderen C; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.; Department of Rheumatology, Reade, Amsterdam, The Netherlands., van der Horst-Bruinsma I; Department of Rheumatology, Radboud University Medical Centre, Nijmegen, Netherlands., van Baarsen LGM; Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands., Landewé R; Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands., van de Sande MGH; Department of Rheumatology and Clinical Immunology and Department of Experimental Immunology, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.; Amsterdam Rheumatology and Immunology Center, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Jan 04; Vol. 63 (1), pp. 34-40.
DOI:	10.1093/rheumatology/kead155
Abstrakt:	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. (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
Databáze:	MEDLINE
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