THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14


PROs, new therapies, combined management shape modern psoriatic arthritis treatment

It is estimated that clinicians miss about half of a patient’s symptoms during routine office visits.

“The consequences of this include increased patient suffering, potentially preventable functional limitations such as missed work, and unnecessary medical visits, medical tests, and visits to emergency departments and/or other providers,” said Jessica Walsh, MD, MBA, MSCI, associate professor of rheumatology, University of Utah Medical Centers and Salt Lake City Veteran Affairs.

Jessica Walsh, MD, MBA, MSCI
Jessica Walsh, MD, MBA, MSCI

The use of patient-reported outcomes (PROs) may be a salve for these less than desirable outcomes, although PROs are not without their own drawbacks, Dr. Walsh said during PsA: Treatment in Practice. Registered attendees of ACR Convergence 2020 have on-demand access to watch a replay of the session through Wednesday, March 11.

Traditionally used in research, PROs have expanded into health-care quality evaluations as well as clinical practice since being introduced to rheumatology in the 1980s.

“We are changing the way we think about PROs and disease assessments,” Dr. Walsh said. “Initially PROs were considered ‘soft,’ but with increasing data demonstrating how well they can work, they have become more widely accepted.”

PROs can help facilitate patient-centered decision-making and improve communication between patients and doctors, resulting in higher patient satisfaction and quality of life.

“Over time, we have broadened our concept of rheumatologic health from a more limited biomedical scope involving objective inflammation to a broader scope inclusive of psychosocial aspects of disease,” Dr. Walsh said.

The proliferation of PRO types in recent years creates more opportunities for clinicians, but also a significant barrier to implementation. The selection process can be overwhelming, as providers must evaluate the psychometric properties, visibility, and other aspects of each PRO. Then they must be able to interpret and respond to the results for the selected PRO, answer patient questions, and teach clinic staff about the PRO—for every disease commonly encountered in the clinic.

A National Institutes of Health initiative launched in 2004 to overcome this hurdle. Patient-Reported Outcomes Measurement Information System (PROMIS) was initiated to identify PROs that could be applied across multiple diseases; however, the relevant PROMIS instruments have not yet been fully evaluated in psoriatic arthritis, Dr. Walsh said.

Arthur Kavanaugh, MD, professor of medicine, University of California, San Diego, provided an update on clinical trials in psoriatic arthritis, discussing adjunctive therapies, DMARDs, biologic agents such as TNF inhibitors and interleukin (IL) inhibitors, janus kinase (JAK) inhibitors, phosphodiesterase type 4 (PDE4) inhibitors, and experimental therapies in development.

Arthur Kavanaugh, MD
Arthur Kavanaugh, MD

“We’ve seen results across different domains with different mechanisms of action,” he said.
“That’s really been fascinating to try to understand from an immunopathogenic standpoint but also to bring these therapies to our patients so that we can get them to their best possible outcomes,” Dr. Kavanaugh said.

The session’s third speaker, Joel Gelfand, MD, MSCE, professor of dermatology and epidemiology, vice chair of clinical research and medical director of the Clinic Studies Unit, and director of the Psoriasis and Phototherapy Treatment Center, University of Pennsylvania, explored the dynamics of co-management of psoriatic arthritis by dermatologists and rheumatologists.

Joel Gelfand, MD, MSCE
Joel Gelfand, MD, MSCE

“Combined” clinics take many forms. At the University of Pennsylvania, it is achieved through virtual meetings. Additionally, the dominant system involved in the patient’s condition dictates which specialist will prescribe systemic agents in Dr. Gelfand’s combined clinic. If a patient has equally severe joint disease and skin disease, the clinicians will determine their individual roles on a case-by-case basis.

“Communication is key, but we’ve found this to be a very valuable way to get better outcomes for our patients,” Dr. Gelfand said.