Does 'Treat-to-Target' Work for Psoriatic Arthritis?
The treat-to-target strategy是如此简单的是常识的边界：患者和她的医疗保健提供者发展目标 - 一种疾病或最小的疾病活动 - 以及用药，他们以快速的速度向该目标工作。使用疾病活动评分系统测量进展。如果患者在三个月（或在某些情况下，一个月）基准中没有改善，则会加剧治疗。
Treat-to-target is widely used by rheumatologists for patients with rheumatoid arthritis. (In astudy published in 2015, rheumatoid arthritis patients who were treated to target were 52 percent more likely to achieve remission than their peers receiving traditional treatment.)
But with psoriatic arthritis, treat-to-target has been slower to catch on. The target, it seems, is a moving one.
“Heterogeneity of disease in psoriatic arthritis makes it more complex,” says Dr. Arthur Kavanaugh, a rheumatologist and clinical immunologist practicing at UC San Diego Health in California. “In addition to peripheral inflammatory arthritis, as patients with rheumatoid arthritis have, patients can have spinal inflammatory arthritis, skin psoriasis, nail psoriasis, enthesitis, and potentially concomitant irritable bowel disease and uveitis.”
Earlier this year,Annals of the Rheumatic Diseasespublished updated treat-to-target recommendations for psoriatic arthritis. According to the recommendations, the treatment target should be clinical remission, but low disease activity could be an alternative.
As Dr. Kavanaugh noted in his email interview with HealthCentreal, the report also highlights the complexity of measuring activity in a disease that manifests in both the joints and skin. Should rheumatologists use a scoring system to assess disease activity on the skin? Should dermatologists assess joint pain?
According to the report: “At some point, the discussion was stopped because all arguments had already been heard with no resolution of the methodological dissent. Given this difference of opinions, it was suggested that further research needed to be performed in[psoriatic arthritis].”
Dr. Kavanaugh, who serves on the board of the internationalGroup for Research and Assessment of Psoriasis and Psoriatic Arthritis, says there’s room for growth.
“我想我们可以做得更好，”他说。“去年挪威出版了一项很好的研究Journal of Rheumatologyshowing that even in a country with great healthcare access and great access to medications, that a number of people did not have great disease control. Psoriatic arthritis lags behind rheumatoid arthritis in that regard.”
The141年研究银屑病关节炎患者, which Dr. Kavanaugh co-authored, found that only 22.9 percent of patients met the criteria for minimal disease activity. Roughly 30 percent of patients had never taken disease-modifying drugs at all.
“It takes a while for new concepts to be adopted,” Dr. Kavanaugh says. “Treat-to-target started earlier in rheumatoid arthritis and has become more accepted. It is newer to psoriatic arthritis, so hopefully it will get accepted more and more over time.”
Patient preferences matter as well, he says.
“Treat-to-target, being new in psoriatic arthritis, is something patients have not heard a lot about, again lagging behind rheumatoid arthritis,” says Dr. Kavanaugh. If treat-to-target is something you would consider, talk to your doctor about his or her knowledge of the strategy.
Kavanaugh博士说，尤其重要，是医生在“评估所有疾病领域并与患者致力于呈现治疗策略来实现所有领域的最佳结果。”
